Implementing Interprofessional Education Into Clinical Experiences: Athletic Training Faculty Perceptions

KEY POINTS

• Interprofessional education during clinical education should involve intentional placement, assessment, and direct mapping to programmatic goals and curriculum.

• Preparing preceptors for IPE through development opportunities, clear objectives, and active facilitation should occur before learners are assigned to clinical experiences.

• Assessment of IPE and collaborative practice during clinical education requires intentional effort from program faculty and preceptors.

INTRODUCTION

In response to the ever-changing landscape of health care delivery, accrediting bodies for health care education programs across the United States now include interprofessional education as part of their accreditation standards (eg, Accreditation Council for Occupational Therapy Education,¹ Accreditation Council for Pharmacy Education,² Accreditation Review Commission on Education for the Physician Assistant,³ American Speech-Language Hearing Association,⁴ Commission on Accreditation of Athletic Training Education [CAATE],⁵ Commission on Accreditation in Physical Therapy Education,⁶ Commission on Collegiate Nursing Education,⁷ and Liaison Committee on Medical Education⁸). Clinicians entering practice are expected to know their roles and responsibilities and to be able to step into a largely collaborative workspace with other professionals to provide care as a productive, interdisciplinary team.^9,10 To prepare learners for this type of practice, educators and program administrators are using various strategies to integrate interprofessional education (IPE) into curricula.^10,11 The World Health Organization¹² defines IPE as occurring when students from 2 or more professions come together to learn from, about, and with one another. Research suggests health care learners who engage in IPE demonstrate an increase in knowledge regarding the roles and responsibilities of other health care professionals, develop a greater respect for other health care team members and their contributions to patient care, begin to understand the necessity of collaboration to improve patient outcomes, and gain additional perspective on ethics.^13–15

Whereas IPE is a relatively new emphasis for health care education, clinical education is a long-standing and essential component of professional health care education.^5,6,8,16 During clinical education experiences, learners engage in opportunities designed to prepare them for independent practice and apply their knowledge and skills with a real-time patient population under the direct supervision of a credentialed clinician.¹⁷ Clinical education serves as a period of professional socialization by allowing learners to assume some of their professional roles and responsibilities while applying their clinical skills.^16,18,19 Traditionally, educators and preceptors have focused clinical education experiences on the development of essential clinical skills; however, IPE provides opportunities for learners to engage with individuals from other disciplines during their clinical education experiences.

Learners are engaging in didactic educational opportunities regarding IPE and understanding the importance of collaboration through IPE programs.^13,20 However, reinforcing these concepts during clinical education and allowing learners the opportunity to practice these collaborative skills in a realistic clinical setting may result in greater collaboration upon entrance to their desired profession. There is a relative paucity of research related to IPE during clinical education.²¹ The majority of interprofessional clinical opportunities seem to occur as short-term experiences^21,22 or in student-run clinics where learners from different disciplines provide care collaboratively.^23,24 Whereas the design and implementation of interprofessional clinical education experiences vary, they appear to have a positive effect on learners' perceptions of their ability to work as a team.^25,26 To improve student learning outcomes and ultimately patient care, the methods in which IPE is implemented in athletic training clinical education requires further investigation. Therefore, the purpose of our study was to explore how professional postbaccalaureate athletic training programs are integrating IPE from a clinical education perspective.

METHODS

Research Design

Because the aim was to explore athletic training educators' experiences connecting IPE to student experiences, we chose a consensual qualitative research (CQR) design.^27,28 CQR finds its roots in grounded theory, phenomenology, and comprehensive process analysis, and its design allows members of the research team to use an inductive approach to explore the phenomenon and data naturally while limiting bias.²⁷ For this study, the research team consisted of 4 athletic training educators/researchers, and we collaborated on all aspects of study design including developing the procedures and interview protocol. This study was approved by the university institutional review board before participant recruitment. In addition, we provided a flowchart for the procedures of data collection, analysis, and trustworthiness measures (Figure 1). To ensure that we thoroughly explained the processes we used for this research, we consulted a criteria checklist for reporting qualitative research while writing and presenting the procedures.²⁹

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Participants

We used purposive sampling and invited the coordinators of clinical education from graduate professional athletic training programs to participate in our study. Individuals were eligible to participate in the study if they had been employed by their current institution for at least 12 months and if the program was in good standing with the CAATE. If the coordinator of clinical education felt there was another program faculty member who had more knowledge regarding the integration of IPE in the program, we asked them to forward the invitation to that faculty member. A total of 17 program faculty participated in our study, and all met the inclusion criteria. Demographic information for participants can be found in Table 1, and information regarding their institution can be found in Table 2. All program faculty provided consent to participate via email and again verbally before the phone interview.

Table 1 Program Faculty Demographic Data

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Table 2 Characteristics of Participant Institutions

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RESULTS

The results presented here are part of a larger study.³⁰ Although the previous publication of these data focused on the didactic portion of the results; the program faculty were also asked about integrating IPE into clinical education. The results related to clinical education are presented here.

Participant responses varied regarding how programs were integrating IPE into clinical education. Some programs were intentional about learner placement for interprofessional experiences during clinical education experiences, whereas others identified examples of unintentional IPE occurring. Some program faculty described the inclusion of health care professionals during clinical education as opposed to other learners from other health care disciplines. A frequency summary of programs describing each of these situations can be found in Table 3.

Table 3 Frequency Counts for Clinical Integration

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Two themes emerged regarding the integration of IPE during clinical education: clinical experience and preceptor involvement. Clinical experience included four subthemes of intentional placement, organic IPE, assessment, and linking to courses. Preceptor involvement included three subthemes of preceptor development, clear objectives, and active facilitation (Figure 2).

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DISCUSSION

Interprofessional education is increasing in importance at the professional and educational levels across health care disciplines. To prepare learners to engage with other health care disciplines, their education should include learning about, from, and with other health care learners to ensure they understand the roles and responsibilities of each profession.¹² Ideally, this shared learning begins at the programmatic level with intentional learner placement in clinical sites with other health care disciplines to ensure they have an opportunity to engage with these other learners. Intentionality can ensure IPE occurs during clinical education, but capitalizing on the organic interactions may be just as beneficial. It is not enough to have students at the same clinical site; they must work and learn together as part of an integrated team sharing knowledge, values, and skills.³¹

One area where interprofessional development for athletic training students can be fostered in clinical education is through soft skills. For professional health care students to develop the skills of collaboration with other health care professionals, students need opportunities to practice collaboratively during clinical education.^15,32 Encouraging preceptors to engage learners in IPE with other learners or professionals during clinical education may help them develop the skills necessary for collaboration in professional practice. Nursing students, for example, who engaged in a clinical experience specific to mental health were able to develop a greater level of empathy, indicating students can learn more than clinical skills during clinical education.³³ Athletic training students reported realistic clinical experiences provided them with the proper socialization and confidence to practice independently upon graduation.³⁴ Part of this socialization includes collaborating with other health care professionals. Work by Ponzer et al¹⁵ demonstrated that interprofessional training in clinical education wards improved learners' ability to develop their own professional roles, while also working on understanding their role in a dynamic health care team.

In support of collaboration, the work of Kirby²⁰ demonstrated that after an IPE learning experience, learners identified the importance of developing an interprofessional mindset, most notably in the area of communication. Specific to the ability to affect and inform clinical practice, learners in Kirby's study illustrated alignment with the IPEC Core Competencies³¹ in that they identified respect, listening, and clear explanations, as well as understanding and appreciating the roles and responsibilities of all members of the health care team, as vital to interprofessional collaboration. These learners also described limited opportunities during clinical education where they could actively engage in interprofessional collaborative practice (IPCP). Primarily, they identified instances where they may have witnessed IPCP in the clinical setting but were not able to actively engage in the process.²⁰ This finding is similar to that of Cavallario and colleagues³⁵ who found that athletic training students only implemented the IPE core competency during approximately 25% of their clinical patient encounters. Creating clinical education opportunities where learners can engage with other learners or professionals³⁵ could help bridge the gap and provide additional moments for communication and soft skill development.

It has been noted that regular collaboration with other health care disciplines in clinical education is lacking in athletic training due to lack of relationships and access.³⁶ Naturally, whereas some clinical education sites may be more suited to implementation of IPE than others, there are opportunities for IPE during clinical education. Despite IPE seeming a challenge, faculty, preceptors, and students must be prepared to capitalize on these opportunities to engage in interprofessional learning opportunities. Program faculty could consider how to develop and encourage preceptors to engage with learners and facilitate interactions between athletic training students and other health care students and professionals during clinical education. However, other research suggests that collaborative approaches to preceptor development have decreased costs and aided in the quality improvement of preceptor development.³⁷ Regardless, the development of preceptors is important because learners have reported higher satisfaction and were more positive about their interprofessional clinical experience when they noted stronger satisfaction with their clinical supervisor.¹⁵

As presented by Schwieterman and colleagues,³⁸ preceptor development is vital to successful IPE and interprofessional collaboration in health care. As continuing professional education in IPE for preceptors is needed, one way to accomplish this could be through short, online educational modules. Schwieterman et al³⁸ identified that asynchronous materials taking less than 15 minutes improved preceptor behaviors, beliefs, and attitudes toward IPE and collaborative practice. Program faculty may consider such modules or similar continuing professional education to educate their preceptors in IPE. Additional educational opportunities and resources are available through the Interprofessional Education Collaborative.³⁹ Other resources include, though are not limited to, educational content for the IPEC Core Competencies for interprofessional collaborative practice,³¹ publications on quality practices for developing IPE opportunities,⁴⁰ as well as the MedEdPORTAL (https://www.mededportal.org/)⁴¹ which is an open-access journal for health professions teaching and learning. Preparing preceptors to model and facilitate IPE and collaborative practice during clinical education should have a positive effect in helping to cultivate practice-ready ATs who can engage as part of the larger health care team.³⁸

From a program communication standpoint, identifying clear objectives for preceptors to emphasize IPE and encouraging them to include students in their interprofessional interactions during clinical education could be beneficial. For example, the University of New England Center for Excellence in Public Health⁴² recommends beginning with interprofessional team building where preceptors, learners, and other IPE facilitators develop their team dynamics before interacting with patients. Furthermore, they suggest that selecting and implementing a workflow process that pairs different health care learners together to enhance areas such as patient intake, chart review, visit structures, team debriefing, and referral practices is beneficial to achieving successful teamwork.

In addition to preceptor focus, educators involved in IPE could consider expanding their clinical education preparation to include discussion with IPE stakeholders from other disciplines and settings. For example, Missen et al⁴³ suggested that varied programs collaborate to share their IPE goals with each other and stakeholders from their health care partners to identify areas of overlap in requirements, patient interaction, accreditation, and outcomes. By establishing these areas of common ground, explicit and intentional opportunities for interprofessional collaboration during clinical education could occur. Furthermore, leadership of regulatory agencies could establish models that value IPE during the clinical learning process.⁴³ In athletic training, we might consider partnering with physical therapy, occupational therapy, physician assistant studies, or other programs to identify possible community settings where collaborative care could occur. The implementation of intentional collaborative clinical education may enhance ATs' readiness for collaborative practice after graduation. Establishing a scaffolded IPE program that incorporates preceptors as part of the IPE process could lead to expanded ability to assess collaborative practice in the clinical education setting.

Best practices for assessment of IPE in clinical education have yet to be established. At this stage, assessment of clinically based IPE has primarily focused on learner outcomes related to knowledge of roles, responsibilities, and attitudes of and toward team-based care as well as patients.^42,44,45 One example by Garavatti, Tucker, and Pabian⁴⁵ highlighted how medical and physical therapy students increased their comfort in rehabilitation situations after a patient encounter featuring patients with disabilities. Other work has evaluated outcomes of interprofessional shadowing in the clinical setting for learners from nursing.⁴⁶ Although this study did not directly evaluate learner engagement, it did indicate that nursing students noted communication, role identity, learning from other professions, and confidence in collaboration were achievable through observational modeling in the clinical setting.

Several survey instruments have been developed and published that evaluate various interprofessional aspects in learner development and readiness. Instruments such as the Readiness for Interprofessional Learning Scale,⁴⁷ Students Perceptions of Interprofessional Clinical Education Revised,⁴⁸ and the Interprofessional Socialization and Valuing Scale ⁴⁹ are self-report tools that assess learner attitudes and beliefs towards IPE. Although some of these instruments have interprofessional collaborative-practice elements to them, they are targeted to IPE didactic offerings. Although these assessment tools have value to assess IPE, there is also a need to assess the interprofessional collaborative practice that occurs within teams during clinical education. There are instruments that focus more on the collaborative nature of teams such as the Interdisciplinary Team Process and Performance Survey (ITPPS),⁵⁰ Assessment of Interprofessional Team Collaboration Scale (AITCS),⁵¹ and the Collaborative Practice Assessment Too (CPAT)l.⁵² Educators may want to consider evaluating the resources available through the National Center for Interprofessional Practice and Education⁴⁰ that appropriately match their goals and objectives for interprofessional learning. This website includes a collection of measurements tools and guides that could be used to develop an assessment plan for teamwork and performance. Future assessment of IPE in clinical education may expand to include specific practice setting collaborative team and patient outcomes.⁴⁰

CONCLUSIONS

Interprofessional education is slowly expanding as part of clinical education for learners in athletic training. Athletic training program faculty identified beneficial areas of emphasis for IPE in clinical education as intentionality in placement and preceptor involvement. Preparing preceptors for IPE through development opportunities, clear objectives, and active facilitation should be considered. Program faculty should consider how they are currently assessing IPE during clinical education and how students are able to connect these interactions to didactic learning.