do we really teach our students to be interprofessional ... of education... · interprofessional...
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FACULTY OF HEALTH SCIENCES FACULTY SCHOLAR PROJECT
2012 Iris Lindemann
Do we really teach our students to be interprofessional practitioners?
A focus on curriculum within Health Professional Programs
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Do we really teach our students to be interprofessional practitioners?
A focus on curriculum within Health Professional Programs
Contents Page
Abbreviations / Definitions 2
Executive Summary 3
Introduction and Aims 5
Methods 7
Outcomes 8
Interprofessional Education 9
Interprofessional Context 10
Communication Skil ls 12
Teamwork Skil ls 15
Professional Skil ls 18
Client centred approach to care 22
Opportunities for IPE 26
Other considerations for implementing IPE 27
Discussion 28
Potential future directions 29
References 30
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ABBREVIATIONS USED WITHIN THIS DOCUMENT BDCR Bachelor of Disability and Community Rehabilitation BHSc Bachelor of Health Sciences BMBS Bachelor of Medicine Bachelor of Surgery BM Bachelor of Midwifery BND Bachelor of Nutrition and Dietetics BN Bachelor of Nursing BSP Bachelor of Speech Pathology EA Educational Aims FHS Faculty of Health Sciences IP Interprofessional IPE Interprofessional Education IPP Interprofessional Practice LO Learning Outcomes Maud Master of Audiology MND Master of Nutrition and Dietetics MSP Master of Speech Pathology N & D Nutrition and Dietetics
DEFINITIONS OF KEY TERMS USED IN THIS DOCUMENT Interprofessional pract ice ( IPP) relates to those attributes required by professionals for effective collaboration which are based on the same principles as good team work such as shared vision, mutual support and stated goals (Headrick, Wilcock & Batalden, 1998). Interprofessional Education ( IPE) is defined as “Occasions when members (or students) of two or more professions [associated with health and social care] engage in learning with, from and about each other to improve collaboration and the quality of care” (Freeth, Hammick, Koppel, Reeves, & Barr, 2002, p. 12).
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EXECUTIVE SUMMARY This project was supported by the Faculty Scholar Program for 2011/2012 for the Faculty of Health Sciences.
Aims This project used a curriculum mapping approach to investigate current inclusion of IPE and IPP capabilities in core topics within health professional programs in the Faculty of Health Sciences. Inclusion of IPE and IPP capabilities is currently not mandatory or strategically promoted within the faculty and this investigation was exploratory and aiming to ‘stocktake’ the existing declared curriculum relating to IPP.
Methods After enthusiastic engagement from Faculty via a series of program / discipline based meetings, program outlines, EA and LO for all core topics was sourced for graduate-entry health professional programs. Data from 16 undergraduate and graduate-entry programs within FHS were collected. This equated to a total of 290 topics all of which were coded against six nodes using NVivo (QSR International, 2012). Four nodes represented the four areas identified as generic capabilities for IPP (communication, teamwork and professional skills and a client centred approach to care) and two nodes represented evidence that the curriculum was presented in an IP context or was taught as IPE. Where possible, analysis outcomes were discussed with faculty and further information relevant to the inclusion of generic capabilities in the curriculum was sought. Overall outcomes and recommendations were then considered and provided to the FHS Teaching and Learning Committee for use in future planning and discussions relating to IPE within the Faculty.
Key Findings Interprofessional education. Is there any evidence of curriculum being presented to students as IPE? There is very limited evidence of IPE in topic EA and LO across the Faculty. Two examples of IPE in classroom teaching were found:
• Bachelor of Health Sciences core curriculum provides opportunities across three years for students from a range of discipline streams within Health Science Programs to learn together in the same classroom.
• Health Sciences / Nutrition and Dietetics (NUTD 3102: Nutrients: Role and Function) classes combine for students to collaborate in group work with the explicit aim of improving professional perspectives.
All other instances where students are expected to work with other professional disciplines occur within professional placement / practicum which are usually in the final year (s). Not all placement topics placed emphasis on interprofessional practice or care in their EA and LO.
Interprofessional context . Is curriculum being presented to students in an IP context? Within all discipline areas there were topics where EA and LO identified that a multidisciplinary context is presented to students. An IP context was generally not a strong feature of any program, rather was isolated to EA and LO in some topics only. The topic HLTH1305 (BHS) stood out as one with a key emphasis on an IP context within health care and which introduces students to a wide range of health professions in the health system. A number of programs have topics which share teaching with other discipline areas. Discussions with staff revealed that an IP context is emphasized in many topics as an overarching philosophy of practice even when this is not made explicit in EA and LO.
Generic capabil it ies. Are the four generic capabilities for IPP included in curriculum and where are they identifiable? Generic Capabilities needed for IPP (communication, teamwork and professional skills and client centred approach to care) are embedded in EA and LO in most programs but to varying degrees and at different year levels. Mostly EA and LO relating to these capabilities are not expressed in an IP context or as part of IPE.
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Communication ski l ls Most programs offer dedicated time to learning communication skills (B Disability Studies, Health Sciences core, N&D, Medicine, Midwifery, Nursing (Pre-reg.), SP, Audiology). This generally is evident as interpersonal skills or counselling skills (often specific to discipline needs). Communication training where communication competencies are explicitly taught and examined mainly occurs in the early year levels. Communication skills are emphasised in EA and LO of placement topics in later years. Teamwork ski l ls Some programs offer dedicated time to learning teamwork skills (B Disability, Nursing / Midwifery, N&D, SP), often in topis where communication skills are also a focus. Teamwork skills may be described as group facilitation skills or they may be explicitly encouraging effective team functioning. The latter was noted less often in EA and LO. Many topics include “collaboration” in LO even when team / group work was not a focus of the topic. Placement topics often emphasise teamwork in their EA and LO and it was not always clear whether teamwork was assumed to be multi-disciplinary or whether the focus was on teamwork within the discipline or both. It may be that in some programs, students are expected to demonstrate collaborative skills in the classroom or working in a multidisciplinary team in placement without any specific or focussed preparation in this area. Professional ski l ls Professional skills are included in all programs and are strongly emphasised and explicitly described in most, mainly within the context of a single discipline area. Only few programs include EA and LO which explicitly indicate students are learning about the roles of other health professionals (Health Sciences core, Audiology) One Health Sciences core topic provides a clear focus on and overview of legal and ethical requirements within health care which are relevant to a range of health professions and may be a potentially useful topic for use in IPE across programs. Client centred approaches to care Most programs integrate aspects of patient centred care into topics although inclusion and emphasis is variable across programs. Most programs clearly identify the needs of the patient as important. Some programs have a topic dedicated to social aspects of care within their discipline (Nutrition, Health Science, and Nursing) and Nursing offers a topic relating to health care needs of indigenous people. Of note is the B. Disability and Community Rehabilitation which reveals a strong philosophy and consistent commitment to client focussed care that is not evident in other programs.
Potential future directions for further discussion • Changes to incorporate a comprehensive IP context into curriculum are likely to be easier for programs to
implement than changes to embed IPE into curriculum. Some programs expressed that they already do provide an IP context although this is not evident in LO so is perhaps currently incidental to curriculum.
• Changes to embed IPE into curriculum will require agreement from different discipline areas in defining generic capabilities. Initial stages of this process has already been achieved through the Faculty IPE project currently working with GP Plus (IP Education Steering, Research and Evaluation Committee, 2012).
• Change is likely to require a Faculty led initiative which supports all health related programs to provide IP context to teaching and / or to provide IPE experiences for students.
• First year may be a potential place to begin this process as almost all programs provide at least some tuition in the four areas for generic capabilities.
• Communication skills and Professional skills appear to be the IPP capabilities most consistently included in curriculum.
• Practicum topics are the ideal place for ongoing development and monitoring of progressive development of IPP capabilities.
• The development of teamwork and collaborative skills in curriculum could be more consistently evident across the faculty. It is important students are explicitly prepared for collaboration in the classroom and for working in multidisciplinary teams, and that these skills are not assumed.
• Use of exemplars within the Faculty can promote discussion and potential examples of ways to progress IPE.
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INTRODUCTION AND AIMS Interprofessional education... is an opportunity to not only change the way that we think about
educating future health workers, but is an opportunity to step back and reconsider the
traditional means of healthcare delivery. I think that what we’re talking about is not just a
change in educational practices, but a change in the culture of medicine and health-care.
Student Leader (as cited in WHO report 2010, p.6)
IPE IPE is the cornerstone of preparing a future health workforce that is “collaborative practice ready”; ready to work within teams of health workers from a range of professions, able to respond to local needs of patients, their carers and community and able to deliver high quality care across diverse settings and cultures (Barr, Helme & D’Avery, 2011; L-Tipp, 2009; World Health Organisation, 2010). Improved practice based IP collaboration can lead to better outcomes for patients (Barr et al, 2011; Zwarenstein, Goldman & Reeves, 2009; World Health Organisation, 2010). IPE is generally not an accepted part of the health care curriculum in Australian universities (L-Tipp, 2009) and a number of barriers to implementing IPE have been identified. These include a lack of IPE in accreditation standards, a culture of discipline-based training and logistical issues such as timetabling, and planning (L-Tipp, 2009). However there are also increasing examples of successful implementation of IPE providing guidance as to how these barriers may be overcome (Anderson, Cox & Thorpe, 2009; Charles, Bainbridge & Gilbert, 2006; Duncan, Alperstein, Mayers, Olkers & Gibbs, 2006; Mann et al, 2009; Margalit et al, 2009; Wilhelmsson et al, 2009). In order for IPE to be successfully implemented within curriculum it is critical to identify the capabilities required for IPP. Generic capabilities are “the skills, personal attributes and values which should be acquired by all graduates regardless of their discipline or field of study” (Higher Education Council, 1992, p. 20, as cited in Bath, Smith, Stein & Swann, 2004). Recent work at Flinders University (Interprofessional Education Steering, Research and Evaluation Committee, 2012) has defined four generic capabilities for IPP which can provide an educational framework for embedding IPE into curriculum. These capabilities for IPP can be summarized as communication, teamwork and professional skills and a client centred approach to care. The literature supports the use of such framework to ensure generic capabilities are explicit in curriculum (Walsh, Gordon, Marshall, Wilson & Hunt, 2005; Verma et al, 2009; Oandasan & Reeves, 2005; Buring et al, 2009; Thistlewaite & Moran, 2010).
Curriculum mapping Curriculum mapping has been likened to a “Program stocktake” (Bath et al, 2004, p. 318). Curriculum mapping concerns itself with “what is taught (the content, the areas of expertise addressed, and the learning outcomes), how it is taught (the learning resources, the learning opportunities), when it is taught (the timetable, the curriculum sequence) and the measures used to determine whether the student has achieved the expected learning outcomes (assessment)” (Harden, 2001, p. 123). Curriculum mapping can be used for a range of purposes. It is a tool for identifying that the declared, taught, learned and assessed curricula are aligned (Bath et al, 2004; Harden, 2001). It can allow identification of patterns within programs and identify possible directions for future change. Curriculum mapping can also can raise issues about teaching and learning for reflection and discussion and it can provide quality assurance information (Nicholson, 2011). Although there are sound examples of curriculum mapping in the literature, there are few best practice guidelines which outline this process (Sumison & Goodfellow, 2004). Health professional programs generally use an outcomes based approach to education which has a focus on competencies and learning outcomes so it seemed reasonable to
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begin an investigative process at this point when working with health curriculum. Learning outcomes are a statement of what a student should be able to do on completion of their program (Biggs & Tang, 2007). Mapping declared curriculum using learning outcomes is a process supported by Harden (2001) and Tariq, Scott, Cochrane, Lee & Ryles, (2004). As curricula becomes more flexible it is more difficult to map (Tariq et al, 2004) hence it makes sense to include only core topics which all students undertake rather than all topic options available.
Aims This project used a curriculum mapping approach to investigate current inclusion of IPE and IPP capabilities in core topics within health professional programs in the Faculty of Health Sciences. Inclusion of IPE and IPP capabilities is currently not mandatory or strategically promoted within the faculty and this investigation was exploratory and aiming to ‘stocktake’ the declared curriculum which currently exists relating to IPP. Topic aims and learning outcomes were investigated for the presence of IPE and against core generic capabilities for IPP. Programs included were limited to graduate-entry training. The project aimed to investigate the following questions:
Are the four key IPP generic capabilities currently included in curriculum within health professional programs and where are they identifiable?
How are these four IPP generic capabilities being presented to students within the curriculum i.e. discipline context or an interprofessional context?
Are any of the four IPP generic capabilities being presented as part of an IPE program? Are there any similarities in the learning of generic capabilities across discipline areas and where there may be
opportunities for students to be sharing learning as part of an interprofessional education program?
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METHODS The project was conducted across four stages
1. Engagement and Data col lect ion Faculty were engaged in the project through a series of program / discipline based meetings where project aims were discussed and voluntary participation sought. Data was collected through follow up meetings where staff provided overview details of their programs for analysis, with emphasis on aims and learning objectives. When this could not be arranged information was sourced from the program website. Data relating to program outlines and aims and learning objectives for all core topics was sourced for all graduate-entry health professional programs. Data from 16 undergraduate and graduate-entry programs within FHS was collected including:
o Bachelor of Health Sciences (Nutrition, Life Sciences, Health Management, Health Promotion, Paramedics, Disability and Community Inclusion)
o Bachelor of Disability and Community Rehab o Bachelor of Medicine Bachelor of Surgery o Bachelor of Midwifery (pre-registration) o Bachelor of Nursing (pre-registration) / Bachelor of Nursing (grad entry) o Bachelor of Nutrition and Dietetics / Master of Nutrition and Dietetics (grad entry) o Bachelor of Speech Pathology / Master of Speech Pathology (grad entry) o Master of Audiology (grad entry)
2. Analysis Data from a total of 290 topics was collected and of these 204 topics contained information relevant to the aims. Program information was entered into NVivo (QSR International, 2012) and coded against six nodes. Four nodes represented the four areas identified as generic capabilities for IPP and two nodes represented evidence that the curriculum was presented in an IP context or was taught as IPE. All coding was done by the author but was rechecked in at least 2 -3 coding cycles over time for each program as coding definitions were refined and findings were confirmed.
Definit ions used for coding Interprofessional education: Coded when there is explicit evidence of students from different disciplines working together in the same classroom or students being required to work with other professionals within health care teams. Interprofessional context: Coded when there is evidence of teaching / learning which explicitly included perspectives from other discipline areas. I.e. learning about interprofessional care, activities, roles and responsibilities of other health professionals, interprofessional relationships Communication skil ls: Coded when there is evidence of teaching of oral and written communication skills. It includes teaching of skills for working with patients to establish a therapeutic relationship and skills for communicating with other health professionals, including conflict resolution. Record keeping and development and use of written communications media are also included. Teamwork: Coded when there is evidence for students receiving explicit instructions about teamwork or collaboration. Includes teaching of group work / teamwork skills, leadership, establishing/ maintaining team function, negotiation for conflicts within teams, interprofessional teamwork, ethical behaviour within teams and team decision making. Includes when students learn to collaborate with other disciplines to maximise client outcomes. Professional ski l ls: Coded when there was evidence of the explicit teaching of professional issues and behaviours, including professional ethics. This included learning about other professions and their roles,
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understanding one’s own profession, understanding professional boundaries, evidence of respect towards other professions and valuing their contribution, understanding legal and ethical requirements of professions in team, reflection and critically appraisal and evaluation of outcomes of practice. Client / person / patient centred care: Coded when there was explicit evidence of patient centred approaches to care in LO. This can be described in a range of ways i.e. understanding the patient’s agenda, understanding the social context of the patient’s life, focus on the importance of family and carers. Key components of client centred care such as ethical practice (duty of care, respect, negotiated care, focus on improving quality of care through teamwork and communication), values (attitudes, personal and team values), cultural safety and skills such as negotiation were not coded to this node unless explicitly referred to as part of a patient centred approach.
Bachelor of Health Science streams were considered individually initially, however a significant portion of the EA and LO relating to generic capabilities were found in the core topics which were common to all streams. It was decided to report on only the core topics and special mention has been made where core topics specific to a stream have provided areas of teaching which enhanced the inclusion of generic capabilities. Note that pragmatic, one-off IPE initiatives (such as described by Barr, 2012) with only small numbers of students were not included in this analysis as they are not strategically or systematically embedded in curriculum. The aim was not to devalue these often fruitful initiatives, however they were outside of the scope of this investigation.
3. Re-engagement After the first round of analysis, where possible, analysis outcomes were discussed and further information relevant to the inclusion of generic capabilities in the curriculum was sought. This was an iterative process whereby outcomes could be confirmed with discipline staff to confirm that the outcomes represent the program content and processes. This was not possible for all programs due to time and workload constraints. Also, not all program coordinators felt they could discuss their program at the topic detail required and it was not possible to connect with all relevant individual topic coordinators.
4. Outcomes Overall recommendations considered and provided to the Faculty Teaching and Learning Committee for use in future planning and discussions relating to IPE within the Faculty.
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OUTCOMES On initial approach, all discipline areas were very positive about IPE and acknowledged the importance of collaborative practice in the professional setting. All discipline areas were very willing to participate in the project and provide program information for analysis.
Interprofessional education Is there any evidence of curriculum being presented to students as IPE?
Coding Definition: Interprofessional education was coded when there was explicit evidence of students from different disciplines working together in the same classroom or students being required to work with other professionals within health care teams.
Summary of analysis: There is very limited evidence of IPE in topic EA and LO across the Faculty. Two examples of IPE in classroom teaching were found:
• The Bachelor of Health Sciences core curriculum provides opportunities across three years for students from a range of discipline streams within Health Science Programs to learn together in the same classroom. Classroom activities range from being interprofessional (interprofessional case studies where students collaborate to plan health management) to discipline based (students being separated into discipline groups for discipline based activities).
• Interprofessional education situated within the classroom and embedded in curriculum was identified in only one example. Health Sciences / Nutrition and Dietetics (NUTD 3102: Nutrients: Role and Function) classes combine for students to collaborate in group work with the explicit aim of improving professional perspectives.
“Collaborative work in the group project between students from the Bachelor of Nutrition & Dietetics and Bachelor of Health Sciences will broaden the professional perspective for each cohort of students.” (NUTD 3102)
All other instances where students are expected to work with other professional disciplines occur within professional placement / practicum which are usually in the final year (s). Not all placement topics placed emphasis on interprofessional teamwork or care in their EA and LO. It was outside the scope of this study to determine how much IPE during placements was explicitly planned or remained opportunistic, or whether students’ IPP capabilities were included in assessment.
Examples from EA and LO in practicum topics include: Health Sciences Core
“Develop competency in working professionally with professionals and consumers.” (HLTH3106)
Additional evidence in EA and LO in N&D and Health Promotion streams:
“Develop competency in working professionally with professionals and peers in teams.” (HLTH2106)
B Disability and Rehabilitation
“This topic aims to provide students with the opportunity to learn about...Working alongside professionals in
the provision of services to people living with disability and those who support them.” (DSRS2232)
Nutrition and Dietetics
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“An ability to work as an effective member of a team and work collaboratively and productively with a range of people and professions” (NUTD4108/9221)
Speech Pathology / Audiology
Not evident in EA or LO
Medicine:
“Practice patient care as part of a clinical team.” (MMED8302/3)
“the ability to work in teams with medical and health professional colleagues.” (MMED8402/3)
Nursing / Midwifery
“Establish and maintain constructive relationships with all members of the health care team.” (MIDW3306)
“demonstrate that they can function as an effective novice member of the health care team”. (NURS3104)
Interprofessional context Is curriculum being presented to students within the curriculum in an IP context?
Coding Definition: Interprofessional context was coded when there was evidence of teaching / learning which explicitly included perspectives from other discipline areas. I.e. learning about interprofessional care, activities, roles and responsibilities of other health professionals, interprofessional relationships.
Summary of analysis: Within all discipline areas there were topics where EA and LO identified that a multidisciplinary context is presented to students. Emphasis is placed on understanding the role of one’s own discipline within a multidisciplinary team, communication across multi-disciplinary boundaries and the multi-disciplinary team management of a client. An interprofessional context appeared to not be a strong feature of any program, rather was isolated to EA and LO in some topics only.
• Health Sciences stood out as containing the topic HLTH1305 which has a key emphasis on an interprofessional context within health care delivery and introducing students to a wide range of health professional disciplines within the health system in detail.
• A number of programs emphasise teaching provided by staff from other discipline areas. These include BHlth Sc core (range of disciplines), Paramedics (medical staff especially), SP (range of disciplines) and BMBS (range of scientists and disciplines)
It should be noted that in discussions with faculty, it was clear that an interprofessional context is emphasized in many topics as an overarching philosophy of practice even when this is not made explicit in EA and LO.
Examples from EA and LO which demonstrate an interprofessional context include:
Health Sciences Core
“explore with students the division of labour in health care across the various disciplines and the impact this has on practice and multidisciplinary care.” (HLTH1305)
“examine various modes of shared/multi-disciplinary care in the light of increased consumer demand, the mal-distribution of health professionals and other factors that have impacted on supply and demand.” (HLTH1305)
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Additional evidence in EA and LO in N&D and Health Promotion streams:
“Develop competency in working professionally with professionals and peers in teams.” (Core Topic HLTH2106)
B Disability and Community Rehabilitation (Is emphasised in all years, especially evident in EA and LO in practicum topics in years 2 and 3)
“This topic aims to provide students with the opportunity to explore and learn about: ..Activities, strategies, roles and responsibilities of professionals working across a range of human service disciplines with community development as an aspect of their role” (DSRS2233)
“At the completion of this topic students will be able to: …Identify the roles/responsibilities of employment professionals in assisting people with disabilities to gain meaningful employment” (DSRS2273)
Nutrition and Dietetics (evident in EA and LO in final year practicum topic and projects in BND and MND)
“Demonstrate understanding of collaboration with broader disciplines and stakeholders, in nutrition program development.” (NUTD 3107)
Speech Pathology / Audiology (evident in EA and LO across multiple topics and years of the BSP, in the final year of the MAud, but not in the MSP)
“The aim of this topic is to....introduce students to the broad parameters of ... working with families from the perspective of guest lecturers from a range of professions: occupational therapy, early education, physiotherapy, nutrition & dietetics and psychology.” (SPTH1105)
“..insight into the nature of multi - professional health care teams and their role with different clients and in different settings.” (AUDI9311)
Medicine: (limited evidence in EA and LO across all years) “The aims of this topic are to ......understand health professional roles and the responsibilities of doctors within health teams” (MMED 8106)
Nursing / Midwifery (limited evidence in EA and LO across all years, especially in the Grad-entry BN)
“The student will have the opportunity to develop: …. the ability to articulate the role of the nurse in the multi-disciplinary team” (NURS1101) “critically examine the role of the midwife in relation to women, their families and a range of health professionals.” (MIDW3303)
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Generic capabilities Are the four generic capabilities for IPP included in curriculum and where are they
identifiable? Overal l summary: Generic Capabilities needed for interprofessional practice (communication, teamwork and professional skills and client centred approach to care) are embedded in EA and LO in most programs but to varying degrees and at different year levels. Mostly EA and LO relating to these four areas of capabilities are not expressed in an interprofessional context or as part of interprofessional education.
Communication ski l ls Coding Definition: Communication skills were coded when there was evidence of teaching of oral and written communication skills. It includes teaching of interpersonal skills for working with patients to establish a therapeutic relationship and skills for communicating with other health professionals, including conflict resolution. Record keeping and development and use of written communications media are also included.
Summary of analysis: Most programs offer dedicated time to learning communication skills (B Disability Studies, Health Sciences
core, N&D, Medicine, Midwifery, Nursing (Pre-reg.), SP, Audiology). Only SP and Medicine EA and LO refer to building on skills across years. Paramedics currently has only limited dedicated time to communication skills as it is no longer a course requirement for students to take the BHSc core communication topic (HLTH1304).
Communication training where communication competencies are explicitly taught and examined mainly occurs in the early year levels. Communication skills are usually emphasised in placement topics in later years.
Some programs (i.e. B. Disability and Community Rehabilitation and BMBS) appeared to prioritise a focus on interpersonal skills whilst others (i.e. BND, Nursing (pre-reg.)) also included more of an emphasis on skills professional communication and documentation. Often terms such as ‘communication skills’, ‘communicate effectively’, ‘use communication strategies’ ‘enhance oral / written communication skills’ were used in EA and LO. It was not possible within the scope of this investigation to ascertain if these LO were assessed.
Examples from EA and LO where communication skil ls are emphasized as an expl icit and significant component of the topic:
Health Sciences Core (dedicated communication skills topic in year 1. This skills taught in this foundation topic are not clearly reinforced in LO in other core topics in later years.)
“This topic aims to....Develop a minimum set of basic communication skills necessary for effective communication in a variety of health care practice settings.” (HLTH1304)
Additional evidence in Health Promotion, Paramedic, Disability and Community Rehab streams:
Demonstrate effective use of communication skills, collaborative ……. with people with chronic conditions in practice.” (HLTH3107)
“Apply interpersonal skills when dealing with people: the patient; bystanders; colleagues and other health care professionals. Apply communication skills in an effectively case handover and written case report.” (PARA1000)
“use positive and people first language.” (DSRS1201)
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B Disability and Community Rehabilitation (Communication skills provided as a dedicated topic in year1 and year 3 and emphasized in a range of LO in topics across the 3 years. Communication skills are a strong theme in the program.)
“The topic considers interpersonal communication skills and group processes. The first aspect focuses on understanding the self in communication and explores the foundations of effective communication skills with an emphasis on perception, listening skills and verbal and non-verbal communication.” (DSRS1210)
“This topic focuses on the theory and practice of basic counselling skills that are useful in a variety of work and personal settings, with an emphasis on...Understanding counselling theories and their links to practice in a range of human service roles.” (DSRS3222)
Nutrition and Dietetics(dedicated communication skills topic in year 3 BND / Yr 1 MND and emphasized in LO for almost every other topic)
“This topic will introduce students to effective communication and nutritional counselling skills required of Dietitians in entry level professional practice for one on one dietetic counselling, group education and developing educational materials.” (NUTD3104 / 9161)
“By the end of clinical placement, students will be able to demonstrate the following attributes at entry level practice... Communicate in a professional manner to clients and other members of the health care team.” (NUTD4107/
Speech Pathology / Audiology (BSP: Communication skills integrated with clinical skills across a number of clinical practice topics in year 2 and then reinforced in practicum in years 3 and 4, MSP: Communication skills integrated with clinical skills across a number of clinical practice topics in year 1 and then reinforced in practicum in year 2. Speech Pathology programs show evidence of progressive achievement in communication skills in EA and LO. MAud: In Year 1 Communication skills are integrates with professional and clinical studies, then reinforced through emphasis in LO in practicum topics in final year)
“On completion of the topic, students will be able to: Demonstrate basic interviewing skills - establishing a working relationship with clients, and basic skills of active listening and appropriate responsiveness.” (SPTH9202)
“The topic aims to provide students with knowledge of…core areas of professional practice and personal development related to interpersonal skills, observation and aspects of clinical communications oral and written skills.” and “further opportunities to observe and practice communication skills, with a focus on the provision to the client of clear and accurate information, including breaking bad news.” (AUDI9301 / 9311)
Medicine: (Communication skills integrated with clinical skills in clinical practice topics in years 1 and 2 and then reinforced through emphasis in LO in practicum in years 3 and 4)
“Students participate in programmed sessions dealing with communication and patient interaction skills, introductory clinical procedures, history taking and physical examination in medical practice.” (MMED8101/2)
“Topics are based on the course outcomes as follows....a proficiency in basic clinical & communication skills which will enable graduates to practise competently with empathy for patients and with recognition of their own limitations.” (MMED8403)
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Nursing / Midwifery: (BN-Pre-reg: Dedicated communication skills topic in year 1, LO on topics in further years emphasise strongly professional and academic communication rather than patient based communication skills. BN-Grad-entry: Limited evidence of communication skills in EA and LO. BM: Dedicated communication skills topic in year 1 with minimal evidence of emphasis of communication skills in further years in EA and LO.)
This topic aims to introduce students to the basic theory of interpersonal communication, develop beginning level skills for interpersonal communication, and apply theory and skills of interpersonal communication to beginning nursing and midwifery care.” (NURS1104)
“Use appropriate language and accurately describe the diversity of basic health and illness in reference to Indigenous health and culture.” (NURS2724)
“communicate effectively with a variety of health care professionals to plan effective care for the woman and her family.” (MIDW1007)
“provide midwifery counselling.” (MIDW2203)
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Teamwork ski l ls Coding Definition: Teamwork was coded when there is evidence for students receiving explicit instructions about teamwork or collaboration. Includes teaching of group work / teamwork skills, leadership, establishing/ maintaining team function, negotiation for conflicts within teams, interprofessional teamwork, ethical behaviour within teams and team decision making. Includes when students learn to collaborate with other disciplines to maximise client outcomes.
Summary of analysis: In general, teaching of teamwork skills was inconsistent across the Faculty. A number of programs do offer dedicated time to learning teamwork skills (B Disability, Nursing /
Midwifery, N&D, SP), at times in the same topic where communication skills are a focus. Teamwork skills were often described as group skills and EA and LO specified learning was targeted towards students planning, facilitating or leading group education sessions or they were explicitly aimed to encourage effective team functioning. The latter was noted less often in EA and LO.
It is common for topics across a range of disciplines to include “collaboration” in LO even when teamwork was not a focus of the topic, but where collaboration and group skills were expected of students (i.e. working together towards a group presentation). The extent of recording of student achievement and development in collaboration during assessment in these topics was beyond the scope of this investigation.
Placement topics often emphasise teamwork in their EA and LO and these are strongly linked to the EA and LO related to an IP context (above) as these emphasise multidisciplinary teamwork. At times it was not clear from the topic descriptors whether teamwork was assumed to be multi-disciplinary or whether the focus was on teamwork within the discipline.
It may be that in some Programs that students are expected to demonstrate collaborative skills in the classroom or working in a multidisciplinary team in placement without any specific or focussed preparation in this area as there was no evidence within EA or LO.
Examples from EA and LO where teamwork or group ski l ls are emphasized as an explicit and signif icant component of the topic:
B Disability and Community Rehabilitation
“The topic considers interpersonal communication skills and group processes. ... The second aspect gives attention to roles and tasks necessary to maintain a group or organisation. Emphasis is placed on using group and organisational theories in order to act as an advocate for persons with disabilities. This topic adopts an experiential learning approach.” (DSRS1210)
Health Sciences
Nutrition Stream (as for Nutrition and Dietetics) Nursing (Pre-reg.) / Midwifery
“On completion of this topic, students should understand... theory of group dynamics. On completion of this topic, students should be able to.......effectively facilitate a group.” (NURS1104)
Nutrition and Dietetics
“Provide opportunities for students to increase their confidence in working with individuals, groups, developing written educational material and reflective practice and be well prepared for their final year of placements..... Work collaboratively to understand group education theory and effectively communicate and deliver small group sessions.” (NUTD3104 / 9161)
Speech Pathology / Audiology
Successfully implement basic teamwork processes and have knowledge of strategies to problem-solve common forms of group conflict as demonstrated by peer-feedback on small group participation..... Use positive
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collaboration strategies with peers and develop conscious analytical skills in judging their success in working effectively with others.” (SPTH1105)
Examples from EA and LO where teamwork or group ski l ls are a component of the topic but not a key focus:
Health Sciences Core (In year 1, two topics which span the year focus on group skills and students working in teams. These skills are not clearly emphasised in LO in these topics or reinforced in other core topics in later years)
“Extend group work skills developed in HLTH1305 Health Professional Practice 1 to respectful discussion and development of one’s own ideas using the tutorial format.” (HLTH1306). (NOTE: Group skills not mentioned in EA or LO for HLTH1305 but is a primary learning strategy used of this topic.)
Additional evidence in EA and LO in Health Promotion, Life Sciences, Health Management, and Nutrition streams:
“Develop competency in working professionally with professionals and peers in teams.” (HLTH2106)
“Demonstrate effective use of ....collaborative problem identification and goal setting with people with chronic conditions in practice and recognise the value of connection and collaboration with other health workers and support providers.” (HLTH3107)
“Develop generic skills such as the ability to work as part of a team to solve practical problems.” (BIOL1101)
“Students will apply their knowledge by working in teams to solve cases and suggest remedies for 'patients' suffering from nutritional deficiencies or metabolic disorders.” ..... “Collaborate effectively with colleagues to solve problems.” (BIOL2771/2772)
“ Provide students with the opportunity to work with health professionals in multidisciplinary settings and gain experience in team work.” (HLTH3106)
“This topic explains ….. the formation and development of groups and teams; handling conflict and change.” (BUSN1021)
“To improve student team skills, group assessment has been included.” (BUSN2025)
B Disability and Community Rehabilitation (evident in final year and practicum topics)
Working alongside professionals in the provision of services to people living with disability and those who support them. “ (DSRS2232)
This topic provides an introduction to advocacy and negotiation in a team environment.” (DSRS3234)
Nutrition and Dietetics (evident in project-based topics and practicum. ‘Collaboration’ a feature of most topics across all years in both BND and MND)
“Work collaboratively in a group and communicate their work via an oral presentation.” (NUTD1105)
“Work independently and collaboratively to describe significant nutrient interactions in the context of human health & disease.” (NUTD3102)
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“Demonstrate understanding of collaboration with broader disciplines and stakeholders, in nutrition program development.” (NUTD3107)
Encourage students to develop skills in independent …. collaboration.” (NUTD3106)
Speech Pathology / Audiology (evident across a number of topics within MSP, BSP and MAud.)
“Describe the major roles of the speech pathologist including: .... How they work with other professionals.” (SPTH1104)
Describe the role of a speech pathologist and the multi-disciplinary team management of a client.” (SPTH4720)
Describe practical speech pathology skills required for effective teamwork and practice.” (SPTH9122)
Demonstrate graduate abilities in working both independently and collaboratively.” (SPTH9123)
for students to develop skills in a team-based approach to conducting research.” (AUDI9214)
insight into the nature of multi - professional health care teams and their role with different clients and in different settings..... an understanding of productive team relationships and opportunities to observe and analyse these mechanisms.” (AUDI9311)
Medicine: (evident in clinical topics and practicum topics across most years)
“understand health professional roles and the responsibilities of doctors within health teams.” (MMED8105)
“Course learning outcomes addressed in this topic... the ability to work in teams with medical and health professional colleagues.” (MMED8204/8205 / 8403)
“Understand the role of functioning health care teams in patent safety and emergency care, and the factors that contribute to and disrupt team functioning.” (MMED8405)
Nursing / Midwifery (evident in clinical topics and practicum topics across most years for BN (Pre-reg), BN (grad-entry) and BM)
“the ability to articulate the role of the nurse in the multi-disciplinary team.” (NURS1101)
“comprehensively care for patients with moderate to complex health care needs using relevant processes of ...... collaboration with the health care team.” (NURS3101 / 3104)
“demonstrate that they can function as an effective novice member of the health care team.” (NURS3104)
“critically examine their roles and interactions with women and their families as well as with a range of health professionals.” (MIDW2202)
“demonstrate the ability to work collaboratively and productively as a member of a team.” (MIDW3301)
“establish and maintain constructive relationships with all members of the health care team.” (MIDW3306)
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Professional ski l ls Coding Definition: Professional skills were coded when there was evidence of the explicit teaching of professional issues and behaviours, including professional ethics. This included learning about other professions and their roles, understanding one’s own profession, understanding professional boundaries, evidence of respect towards other professions and valuing their contribution, understanding legal and ethical requirements of professions in team, reflection and critically appraisal and evaluation of outcomes of practice.
Summary of analysis: Professional skills are included in all programs and are strongly emphasised and explicitly described in most.
Areas covered include professional behaviours and ethical and legal requirements and responsibilities. Within programs, these skills are situated mainly within the context of their own discipline area.
Only few programs include EA and LO which explicitly indicate students are learning about the roles of other health professionals (Health Sciences core, Audiology)
One Health Sciences core topic provide a clear focus and overview of legal and ethical requirements within health care which are relevant to a range of health professions and an understanding of the roles and responsibilities of a range of health care disciplines and the health system in which they are situated. This may be a potentially useful topic for use in planning IPE across programs.
Examples from EA and LO where Professional skil ls are evident in the topic. Health Sciences Core (A number of topics in Year 1 emphasise ethical, legal and professional behaviours and encourage development of professional identity)
“The aim of this topic is to:….introduce students to a broad variety of contemporary ethical and legal issues emerging within the health care system … provide a framework for resolving problems as they apply to health service delivery. “ (HLTH1003)
“The aim of this topic is to:... familiarise students with the structure and function of the Australian health care system ... explore with students the division of labour in health care across the various disciplines and the impact this has on practice and multidisciplinary care ... encourage students to commence development of their own professional identity as a health professional ... examine various modes of shared/multi-disciplinary care in the light of increased consumer demand, the mal-distribution of health professionals and other factors that have impacted on supply and demand.” (HLTH1305)
Additional evidence in EA and LO in Health Management, Paramedics and Disability streams:
To enable students to ... the legal, ethical and security issues associated with IT systems and information.” (COMP1301)
“Medico-legal constraints of emergency care are introduced to provide students with the fundamentals of appropriate practice.”(PARA1006)
“It explores issues relating to shift work, stress (post-traumatic stress disorder and chronic condition stress).” (PARA1007)
“To provide students with a clear appreciation of the legal and ethical parameters for provision of emergency care in pre-hospital settings.” (PARA3001) “The development of individual professional identity ... Analyse professional concepts relevant to service delivery such as professional behaviours and leadership.” (PARA3005) “Developing an awareness of key issues and professional competencies ... Issues relating to provision of quality services such as duty of care and meeting standards and accreditation processes.” (DSRS2232)
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“An understanding of the ethical and professional issues associated with the counseling process.” (DSRS3222)
An understanding of the ethical, professional and self-care issues associated with the case management process in multidisciplinary team environments.” (DSRS3234)
B Disability and Rehabilitation (Has a dedicated topic to professional ethics and professional issues are reinforced across multiple topics across all years. A number of topics also encouraged reflection on values and practice. Focus is mainly within own discipline)
“The topic focuses on the students' own values as well as the attitudes that pervade our society about people with disabilities using a variety of theoretical frameworks including Social Role Valorisation.”(DSRS1201)
“Have knowledge of ethical and legal issues related to the roles of mentor and advocate.” (DSRS2230)
“Developing an awareness of key issues and professional competencies ... Issues relating to provision of quality services such as duty of care and meeting standards and accreditation processes.” (DSRS2232)
“This topic provides strategies for resolving ethical issues, making ethical decisions, writing policy, relating to clients and managing organisations within disability or rehabilitation frameworks.” (DSRS2235)
“Identify the ethical and professional issues surrounding the use of behavioural interventions.” (DSRS3221)
“An understanding of the ethical and professional issues associated with the counselling process.” (DSRS3222)
Developing an ability to be self-reflective about their own practices and performance in the provision of services to people living with disability ... Show enthusiasm for the profession, demonstrate professional knowledge and be reflective about their practice and career development. ... Show a readiness to accept professional responsibility.” (DSRS3233)
An understanding of the ethical, professional and self-care issues associated with the case management process in multidisciplinary team environments.” (DSRS3234)
Nutrition and Dietetics(evident in EA and LO in practicum topic and projects. Focus is mainly within own discipline)
“understand and appreciate the scope and context of nutrition and dietetics practice in the working environment.” (NUTD3101/9160)
“Programs will be based on principles of evidence-based practice, cultural safety, ethical interventions, multi-disciplinary and inter-sectoral practice.” (NUTD3107/9226)
“Understand the context and requirements of workplace environments, including the value of ethical and professional behaviour.” (NUTD3108/9164)
“Understand the roles and responsibilities of various food service personnel and other stakeholders.” (NUTD4101/9222)
“The placement also gives students the opportunity to demonstrate a competent, organised, professional and ethical approach to work ... Professional attitudes and practices which facilitate growth as a competent Health Professional and demonstrated ability to work as a contributing member or the dietetics department.” (NUTD4107/9220)
”Professional attitudes and practices that reflect a competent health professional who values ethical behaviour and is committed to excellence and life-long learning.” (NUTD4107/9221)
Speech Pathology / Audiology (SP: more evident within EA and LO in BSP topics than in MSP topics. Focus is within own discipline. MAud: Appears limited in EA and LO in MAud topics. Focus is learning about other disciplines and health settings)
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“Provide students with an overview of the role of a speech pathologist, their work settings, and the community in which they work.” (SPTH1104)
On completion of this topic students will be able to ... Provide a basic overview of the provision of health and education services in South Australia, and of the speech pathology services within these sectors. ... “Describe the qualities and skills drawn on by speech pathologists.” (SPTH2903)
“Facilitate development of professional knowledge, attitudes and practice in preparation for professional placements. Describe the role of ethics in speech pathology practice ... Compare and contrast a range of ethics theories. .... Discuss the ethical principles espoused by the professional association, Speech Pathology Australia.” (SPTH3905 / 3906)
“Facilitate exploration of a range of professional issues which relate directly to practice as a speech pathologist, and the transition from student to clinician.” (SPTH4720)
“On completion of this topic, students will demonstrate entry level practical skills in ... Generic professional competencies of Reasoning, Communication, Lifelong Learning and Professionalism.” (SPTH4901/ 4902)
“Demonstrate graduate abilities in working both independently and collaboratively, valuing ethical behavior.” (SPTH9123)
“insight into the nature of multi - professional health care teams and their role with different clients and in different settings. ... insight into the primary orientation and roles of other health and education professionals. ... familiarity with the range of health services to which clients can be referred.” (AUDI9311)
“To introduce students to aspects of health services and their management with a view to enhancing their awareness of management issues.” (AUDI9401)
Medicine: (evidence in EA and LO across all years. Focus is within own discipline.) “Demonstrate acceptable standards of professional behaviour with patients, staff and students.” (MMED8101 / MMED8201)
“This topic introduces core knowledge and concepts that underpin socially responsible health professional practice. It introduces the different aspects of the role of the health professionals in society, including interactions with patients, community groups, civil society organisations and members of a range of professions. This topic introduces ..... foundations of law and ethics, cultural awareness and research, informatics and critical appraisal skills.” (MMED8105/8106)
“In the professional context ... an understanding and an ability to work within the legal and ethical frameworks which determine clinical practice.” (MMED8204)
“a demonstration of personal and professional behaviour which indicates development towards high standards of medical practice and patient care; and a commitment to life-long learning and self-enhancement ... an understanding and an ability to work within the legal and ethical frameworks which determine clinical practice.” (MMED8205)
“Demonstrate the professional attitudes of a clinical practitioner.” (MMED8302/3)
“These topics apply and assess core knowledge and concepts that underpin socially responsible health professional practice to the clinical setting including continuity of patient care, ethics of practice and professionalism. Reflections on theory and practice will enhance coping strategies, professional relationships and ethical and legal issues.” (MMED8304/5)
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“an understanding and an ability to work within the legal and ethical frameworks which determine clinical practice.” (MMED8402)
“Understand the ethical issues likely to be encountered in the junior doctor setting and how to approach these.” (MMED8405)
Nursing / Midwifery (BN (Pre-reg) and BN(Grad-entry: Have a dedicated topic to professional ethics and law. Professional issues are reinforced in some topics. BM has two topics dedicated to professional issues which are reinforced in EA and LO in topic in later years and has a strong focus in this area.)
“a beginning understanding of their professional role.” (NURS1101 / MIDW1002)
“a beginning understanding of their professional role.” (NURS1105)
“introduce students to a broad variety of contemporary ethical and legal issues emerging within the health care system pertinent to nursing practice. ... provide a framework for resolving ethical and legal issues (including knowledge and skills development for responsible decision making in relation to ethical/legal situations) pertaining to nursing practice.” (NURS2104)
“interpret industrial relations policy and hypothesise the impact on their work as a registered nurse.” (NURS3103)
“ introduces students to a wide range of professional issues including how nursing relates to law, ethics, social and political theory, cultural safety, primary health care and mental health.” (NURS2804)
“gain an understanding of midwifery practice in modern Australian society in the context of national and international trends. ... Legal and ethical issues underpinning midwifery practice will be explored.” (MIDW1004)
“critically examine their roles and interactions with women and their families as well as with a range of health professionals.” (MIDW2202)
analyse ethical and legal issues in medication management.” (MIDW2206)
The aims of this topic are to introduce midwifery students to the current and future role of the midwife in Australia in the context of the wider health care system.” (MIDW3303)
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C l ient centred approach Coding Definition: Client / person / patient centred care was coded when there was explicit evidence of patient centred approaches to care in LO. This can be described in a range of ways i.e. understanding the patient’s agenda, understanding the social context of the patient’s life, focus on the importance of family and carers. Key components of client centred care such as client focussed ethical practice (duty of care, respect, negotiated care, focus on improving quality of care through teamwork and communication), values (attitudes, personal and team values), cultural safety and skills such as negotiation were not coded to this node unless explicitly referred to as part of a patient centred approach.
Summary of analysis: Most programs integrate aspects of patient centred care into at least some topics with inclusion variable in emphasis across programs. Only two programs clearly label a ‘client centred approach’ as the priority approach (N&D and Medicine). However, most programs clearly identify the needs of the patient as important. This is demonstrated through curriculum relating to the psychosocial context of health, impact of social influences on health care and the need to provide individualised care. Some programs have a topic dedicated to social aspects of care within their discipline (Nutrition, Health Science, and Nursing). Nursing offers a topic relating to health care needs of indigenous people. Of note is the B. Disability and Community Rehabilitation which shows consistently high regard for the needs of clients through EA and LO in almost every topic within their program. This reveals a strong philosophy and commitment to client focussed care which is not evident in other programs. Although most programs declare curriculum content relating to the ethics of professional behaviours and legal requirements, it is not clear how well this encompasses client focussed ethics of care, and values relating to client focussed care.
Examples from EA and LO where Client centred approaches are evident in the topic.
Health Sciences Core (In year 1and 2, two topics emphasise the importance of recognizing peoples lived social and psychological experiences and how this can impact on health.)
“The topic aims..to expose students to the tension between the patient’s lived experience of illness and the boundaries of professional practice. ... To assist students to assimilate knowledge of the lived experience with critical analysis of professional practice as found in practice guideline. ... To extend student’ knowledge of key social concepts that inform both the lived experience of illness, and health practice. ... To explore how the social concepts (eg., deinstitutionalisation) that underpin practice form the basis for understanding professional care of specific population groups. Eg Indigenous peoples.” (HLTH1306)
“identify psychological influences on how people stay healthy, why they become ill and how they respond when ill.” (HLTH2105)
“Be aware and able to design research that is respectful of vulnerable groups; eg Indigenous Australians.” (HLTH3102)
B Disability and Rehabilitation (This area is a clear strength of this Program. This Program stands alone within the Faculty for its consistent and comprehensive emphasis on ensuring the client is positioned at the centre of care regardless of the topic of instruction. A client centred focus pervades almost every topic and it is clearly articulated to students through EA and LO).
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“Seminars will also provide input from the perspective of a person with a disability. The aim is to equip students with sufficient knowledge to provide constructive input to team discussions of an individual's health care needs, and sufficient skills to address the personal care and community access needs of people with a range of disabilities.” (DSRS1206)
“explore personal values, better understand one's own "uniqueness" and participate in activities designed to provide cultural, ethnic, and diversity awareness. ... explore the effects of being different upon both the person and is/her family. ... understand some of the myths and misconceptions regarding people who are considered to be "different". (DSRS1209)
“Since mentors are often in the position of advocating for people with disabilities, important concepts related to advocacy will be explored as a significant component of the topic. This will address interpersonal, social, and legal issues.” (DSRS2230)
“Community participation, education, health services and lifestyle choices provide the context for exploration of practices that support a quality life for people living with disability.” (DSRS2232)
This topic examines both the concepts and role of community development in the lives of people who are marginalised in our communities. Community participation and lifestyle choices provide the context for exploration of the issues, principles and practices related to community development.” (DSRS2233)
“Examination of the role of service provision in the lives of people living with disability and their families continues. Community, education, health and lifestyle provide the context for exploration of practices that support a life of choice for people living with disability with a focus on individual supports and relationships.” (DSRS2236)
“Demonstrate an understanding of the issues facing individuals with disabilities as they attempt to secure and maintain meaningful employment.” (DSRS2237)
“Examine the impact of having a family member with a disability from the perspective of mothers, fathers, siblings, grandparents and others within the extended family. ... Examine the Indigenous and multicultural variables associated with having a family member with a disability.” (DSRS3220)
Nutrition and Dietetics(evident in counselling topic and one topic dedicated to social aspects of food choice, less explicit in other topics)
“Provide opportunities for students to learn and develop effective communication and nutritional counselling skills for working with clients and patients using a client centred and self management approach.” (NUTD3104/ 9161)
“Enable students to develop an understanding of the complex interrelationship of social, political and economic factors influencing individual food choices. ...Expose students to the social determinants of health and nutrition problems.” (NUTD2105)
“Programs will be based on principles of evidence-based practice, cultural safety, ethical interventions, multi-disciplinary and inter-sectoral practice.” (NUTD3107/ 9226)
“Knowledge and application of skills in nutrition ‘project’ planning including needs assessment, implementation and evaluation.” (NUTD4108)
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Speech Pathology / Audiology (evident and explicit across multiple topics and years of the BSP, less emphasis in EA and LO in topics in the MSP, very limited emphasis in the MAud))
“Demonstrate basic skills in using the on-line Social Atlas of South Australia to access information about the social determinants on children’s health and relate this to the impact on the families they are currently working with as part of their work-integrated learning experience.” (SPTH1105)
“Facilitate in students a client and family-centred approach to working with families and other professionals.” (SPTH2901)
“To facilitate in students a client, family and school-centred approach to working with families and other professionals.” (SPTH2902)
“Determine the client's preferred treatment goals and then select appropriate approaches and treatment tasks to meet those goals.” (SPTH3902/ 3906)
“Introduce what is meant by having an ethic of care.” (SPTH3905)
“Use the Ottawa Charter & International Classification of Function as a basis for describing the impact of communication and swallowing impairment on levels of activity and participation.” (SPTH3908)
“Facilitate integration of factors relating to the social determinants of health.” (SPTH4720)
“The topic integrates a Community Education/Health promotion project, enabling students to examine primary health models of service delivery, and facilitating integration of factors relating to the social determinants of health.” (SPTH49702)
“Determine the client?s preferred treatment goals at different stages of development or disease progression. … Select appropriate approaches and treatment tasks (including AAC where appropriate) to meet prioritized goals.” (SPTH2907)
“To introduce students to the broader issues of lifespan development and the impact of the social context on health.” (SPTH9123/9125)
“knowledge of issues related to hearing and communication of specific minority groups within the community, e.g. non - English speaking people, members of the deaf community, Aboriginal and Torres Strait Islander people.” (AUDI9311)
Medicine: (evident in EA and LO across all year levels) “Understand the patient?s agenda and their experience of their health condition.” (MMED8101)
“Understand the patient centred model of medical practice. ...Advocate for patient care and service as a central focus in medical practice.” (MMED8105/8106/8204/8205)
“Reflect on how patients experience illness within the health care system. ..Apply principles of cultural safety to clinic practice. ..Recognise ethical issues in health care.” (MMED8302)
“Demonstrate an understanding of the significance of family and carers in treatment and rehabilitation, and the ongoing management of chronic disease and disability.” (MMED8303)
“The focus is on understanding health care provision in the health system from the patient's point of view.” (MMED8304/ 8305)
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“an ability to practice in a manner that demonstrates sensitivity to the diverse cultures and contexts in the Australian and international health systems.” (MMED8402/ 8403)
“practise with due regard to available resources and cost-effective measures in a manner which encourages patients to assume increasing responsibility for their own health and to participate in decisions about their health care(MMED8402/ 8403)
Nursing / Midwifery (BN (Pre-reg and Grad-entry) offer one topic dedicated to social aspects of care, and these aspects are reinforced in other topics, although less so in the grad-entry program. Another topic within the Pre-reg program is dedicated to needs of Indigenous people and is unique among topics considered. The BM appeared to be less explicit about a client centred approach to care in EA and LO in most topics.)
“demonstrate a sensitivity to individual understandings of health and illness and the implications for relating to a person.” (NURS1101)
“apply and work with culturally different understandings and experiences of health of individuals and their families. ...discuss the range of meanings of health for a person with a chronic illness or disability.” (NURS1103)
“examine ideas about the social determinants of health care and the value of sociology in understanding the relationship between individuals and health status.” (NURS1108)
“apply the concepts of prevention, primary health care and community care to the care of patients with a variety of illnesses in the stable/unstable illness trajectory across the lifespan. ... understand the nature of illness, chronicity and its self-management by patients.” (NURS2105)
“Students will critically examine the concept of cultural safety as it relates to health and nursing practice. Students will develop a critical understanding of the impacts of racism and discrimination on health and illness.” (NURS2724)
“Students will critically examine the concept of cultural safety as it relates to health and nursing practice. Students will develop a critical understanding of the impacts of racism and discrimination on health and illness. ... understand and implement nursing care from a holistic perspective.” (NURS3101)
“The topic aims to raise the students' awareness of a social model of health and the implications for service delivery.” (NURS2103) identify processes whereby women may define and interpret their own experiences of childbirth.” (MIDW1003)
the central role of the midwife as caregiver, counsellor and mediator of ways to enable the client to maintain control of their health and wellbeing as much as circumstances permit childbirth.” (MIDW2202)
explore the advocacy role of the midwife in relation to the interpretation of women’s experiences of childbearing.” (MIDW3303)
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Opportunities for IPE? Are there any similarities in the learning of generic capabilities across discipline areas and where there may be opportunities for students to be sharing learning as part of an interprofessional education program? IPE is currently not embedded within Faculty programs in a strategic or systematic way.
This means there is lots of room for improvement if changes to embed IPE into curriculum are planned. This analysis of topics within programs indicates that there are no consistent patterns emerging in the way an interprofessional context is emphasised in curriculum. In discussions with faculty, an interprofessional context is considered important and is often discussed with students but is not always included in EA and LO. This is likely to mean that the students understanding and implementation of an IP context in health care is not assessed.
An achievable first step towards change for most discipline areas could be a move towards ensuring that teaching of generic capabilities occurs within an explicit IP context. This may be through ensuring, where possible, that all students are considering professional issues and aspects of care from the perspective of a range of disciplines. Making IPP important and visible in topic EA and LO and subsequently in topic presentation and assessment, will encourage students to focus their learning towards interprofessional approaches. Opportunities are also possible for more cross disciplinary teaching as all disciplines include communication, teamwork, client centred approaches and professional issues within their curriculum.
Interprofessional capabilities are included across all programs, either as dedicated topics or integrated into other discipline based content. First year and placements appear to be where there is a concentration of emphasis on generic capabilities for IPP in curriculum. Communication skills and professional skills appear to be given dedicated time for students to learn concepts and detailed skills in almost all programs in year 1 and so these areas offer potential starting points for IPE.
This does offer an opportunity for IPE as these content areas are already covered in curriculum and may be able to be adapted to suit an IPE approach in the early years, either through common topics or modules.
Some challenges to introducing IPE into health professional curriculum have been identified by this investigation:
• Disciplines locate the teaching of generic capabilities in different parts of their programs. EA and LO encompassing generic capabilities for IPP are often embedded into discipline based content within topics and not ‘stand-alone’. This means that use of common modules or topics would require some programs to alter current curriculum more than others, especially those programs where these skills are integrated into discipline based content.
• Disciplines have differing interpretations of generic capabilities for IPP considered, as seen in EA and LO. In addition, disciplines allocate different time priorities to teaching of generic capabilities considered. This may be due to discipline differences or simply to timetabling restraints which call for priority to be given to some capabilities over others. These issues would be important to discuss with any curriculum changes to embed IPE strategies.
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Other considerations for implementing IPE Anecdotally and informally, the following issues were raised in discussions regarding a move towards IPE and deserve to be mentioned as part of this project even though these were not intended project outcomes:
• There is a clear recognition across the discipline areas that IPP is an important feature of health care practice
• Lack of direction and resources for the development of IPE from the Faculty was seen as a major barrier for developing this into the future
• Some staff expressed exhaustion relating to curriculum change from the recent C2R2 review of curriculum
• Concerns were raised as to how to overcome issues relating to student numbers and timetabling so that IPE can occur
• Expressions that the generic capabilities did need to be taught within a discipline context for accreditation, however there was no requirement for IPE from external professional accreditation bodies.
• Smaller programs expressed concerns that they will be subsumed by bigger courses if shared teaching increases, with the risk they may lose their unique identity
These are issues which need to be discussed and collaborative solutions found in a safe and supportive environment so any new initiatives can be successful for all disciplines.
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DISCUSSION Analysing curriculum for generic skills in topic documentation is an important first step for achieving an overview of the declared curriculum (Bath et al, 2004). This analysis of curriculum is a modest piece of work which remains limited in the conclusions it can assert and leaves many questions unanswered. Where generic capabilities have been identified in topic documentation, it would especially be useful to understand if student achievements and progressive development of capabilities is being monitored and assessed. Generic skills can often be embedded as elements of larger assessment tasks and therefore not explicitly made visible to students or recorded in assessment (Bath et al, 2004). This could be the focus of further work if IPE is to be embraced across the FHS at Flinders University. It is clear after speaking with Faculty staff that only using EA and LO to make decisions about topics and programs can be misleading. The declared (written) curriculum may not always be in alignment with the taught curriculum. This was especially apparent when evaluating an interprofessional context of teaching as this was often not explicit in topic EA and LO despite faculty staff asserting that this was an important component of the taught curriculum. Further work needs to be done to ensure that declared curriculum is congruent with assessed and learned curriculum to ensure students all receive priority curriculum goals. This ‘stocktake’ has unearthed two issues for discussion within the FHS as it moves forward towards becoming more interprofessional. It remains unclear as to the optimal time to introduce IPE into health professional curriculum (L-Tipp, 2009) Some feel it is better to introduce IPE early in training before professional identities are formed and other argue for a later introduction as students must understand their own roles before understanding the roles of others (Hoffman and Harnish, 2007; Ker, Mole & Bradley, 2003; Oandasan & Reeves, 2005)). This investigation has revealed that at Flinders University we have potential for embedding IPE at either or both levels. In the early years, there are potential content areas which are shared across disciplines. In practicum topics across disciplines in the later years, the emphasis on IPP capabilities in topic LO could be exploited in order to develop explicit and shared IPE strategies. When considering how to introduce IPE, it is important not just to add-on courses which isolate generic skills from their context and may result in a fragmented curriculum. Generic skills are best taught embedded in a discipline based context even though this can at times render them indistinguishable in curriculum (Bath et al 2004). At Flinders University, some disciplines have worked hard to embed generic capabilities into discipline based content whilst still maintaining their visibility. These programs would find it difficult to avoid duplication within curriculum if generic ‘add-on’ topics were adopted for all programs. This is a challenge which will need to be addressed for IPE to be successful at Flinders. This investigation has revealed some standout examples of effective practice in promoting capabilities for IPP within their discipline area. The B Disability and Community Rehabilitation has demonstrated strong commitment to patient centred approaches to care, the B. Speech Pathology has demonstrated progressive monitoring of communication skills throughout all years of their program and Health Sciences core topics cover almost all components needed to ensure generic capabilities are included, just to name a few. It may be useful to consider whether any of these exemplars may be able to contribute to new IPE initiatives. Significant variation in how generic capabilities were interpreted across disciplines was note in this study, as has been noted by other similar work (Sumison & Goodfellow, 2004). Use of local exemplars may encourage discussion and reflection on IPP capabilities as these must be agreed on before progress can be made to share curriculum. The recently completed IPE project with GP-Plus has also developed definitions for interprofessional capabilities which could be used for these discussions (IP Education Steering, Research and Evaluation Committee, 2012). The reason for undertaking this ‘stocktake’ of curriculum was to look at current curriculum using an interprofessional lens and understand better how we are promoting IPP within curriculum across the Faculty. This information may
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assist program developers within the faculty to reflect on their own programs and perhaps even for programs to start working together more to promote IPE. Curriculum mapping approaches can encourage opportunities for discussing curriculum, for sharing sound practice and can provide a platform for shaping the IPE agenda (Sumison & Goodfellow, 2004; Tariq et al, 2004). This investigation was conducted in a spirit of exchanging information so academic teachers and program planners could consider the position of their programs in terms of IPE and IPP. It is the authors hope that this work will stimulate further discourse and encourage collegiality and collaboration and contribute in a small way to developing IPE at Flinders University.
POTENTIAL FUTURE DIRECTIONS FOR FURTHER DISCUSSION
The following points summarise key potential future directions for IPE arising from this investigation which warrant further discussion within the Faculty.
• Changes to incorporate a comprehensive IP context into curriculum are likely to be easier for programs to implement than changes to embed IPE into curriculum. Some programs expressed that they already do provide an IP context although this is not evident in LO so is perhaps currently incidental to curriculum.
• Changes to embed IPE into curriculum will require agreement from different discipline areas in defining generic capabilities. Initial stages of this process have already been achieved through the Faculty IPE project currently working with GP Plus (Interprofessional Education Steering, Research and Evaluation Committee, 2012).
• Change is likely to require a Faculty led initiative which supports all health related programs to provide IP context to teaching and / or to provide IPE experiences for students.
• First year may be a potential place to begin this process as almost all programs provide at least some tuition in the four areas for generic IPP capabilities.
• Communication skills and Professional skills appear to be the IPP capabilities most consistently included in curriculum.
• Practicum topics in the later years are the ideal place for ongoing development and monitoring of progressive development of IPP capabilities.
• The development of teamwork and collaborative skills in curriculum could be more consistently evident across the faculty. It is important students are explicitly prepared for collaboration in the classroom and for working in multidisciplinary teams, and that these skills are not assumed
• Use of exemplars within the Faculty can promote discussion and potential examples of ways to progress IPE
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