Abstract
Healthcare providers, including psychologists who work as health service providers and with older adults, must be able to work effectively with professionals from other disciplines. Interprofessional education (IPE) engages students from two or more professions to learn collaboratively. To date, only a few studies have examined psychology student involvement in IPE. This article describes the experience of clinical psychology (Psy.D.) doctoral students (
The ability to work effectively with professionals from other disciplines is an essential competency for healthcare providers (Frenk et al., 2010; Greiner & Knebel, 2003; Interprofessional Education Collaborative Expert Panel (IPEC), 2011; World Health Organization (WHO), 2010), such as psychologists who serve as health service providers (HSPs; Health Service Psychology Education Collaborative (HSPEC), 2013) and those who work with older adults (American Psychological Association (APA), 2014; Karel, Gatz, & Smyer, 2012; Partnership for Health in Aging Workgroup on Interdisciplinary Team Training, 2011). Moreover, with the arrival of the Affordable Care Act (ACA; Rozensky, 2014), integrated primary care (McDaniel et al., 2014), and patient-centered medical homes (Nash, Kheatri, Cubic, & Baird, 2013) the ability to collaborate across professions has become increasingly important for psychologists. The “triple aim” – better patient care, better health outcomes, and decreased costs associated with healthcare – is believed to result from effective interprofessional (IP) functioning (Cuff, 2013).
Nonetheless, many healthcare professionals do not receive formal training in team-based care, resulting in them being unprepared for this professional role (Nash et al., 2013). Interdisciplinary education is crucial to interdisciplinary practice (Greiner & Knebel, 2003). Interprofessional education (IPE) may be defined as, “when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve outcomes” (WHO, 2010, p. 7). Experiential learning is crucial to IPE (Cuff, 2013); team-based learning and IPE cannot be confined to traditional classroom-based learning (Frenk et al., 2010).
Recent review studies suggest mixed outcomes of IPE. Studies indicated that participants learned knowledge and skills necessary for interprofessional collaborative practice (Hammick, Freeth, Koppel, Reeves, & Barr, 2007; Reeves, Goldman, Burton, & Sawatzky-Girling, 2010a). Likewise, most studies reported positive results, in terms of changes in learner perceptions and attitudes (Reeves et al., 2010a), and that IPE positively affects learner attitudes about other professional groups (Reeves, Tassone, Parker, Wagner, & Simmons, 2012). In addition, research has indicated that IPE positively changes views of IP collaboration and the value of collaborative work (Lapkin, Levett-Jones, & Gilligan, 2013; Reeves et al., 2010a; Reeves et al., 2012). However, the generalizability of the effects of IPE has been called into question (Lapkin et al., 2013; Reeves et al., 2010b), as well as whether such improvements might be sustained over time (Lapkin et al., 2013). Moreover, the Institute of Medicine (IOM, 2015) has noted a disconnect between the educational and health care delivery systems which results in difficulty assessing the impact of IPE interventions on health and systems outcomes, such as the triple aim.
Recent guidelines for practice within professional psychology identified valuing IP relationships, collaboration, and team-based care as an essential component of interprofessional competency (APA, 2014; HPEC, 2013; McDaniel et al., 2014; Nash et al., 2013). In addition, these guidelines recognized appreciation of the unique contributions and knowledge that different healthcare professionals bring to the healthcare team as an important element of IP practice (APA, 2014; HSPEC, 2013; McDaniel et al., 2014; Nash et al., 2013). Hence, IPE could influence values and attitudes related to the aforementioned aspects of practice in professional psychology and provide an opportunity for practicing skills that are central to IP collaboration and team work.
Only a few models of psychology student IPE involvement have been described in the literature (Hadjistavropoulos et al., 2015; Howell, Wittman, & Bundy, 2012; Wellmon, Gilin, Knauss, & Linn, 2012; Zucchero, Hooker, Harland, Larkin & Tunningley, 2011; Zucchero, Hooker, & Larkin, 2010; Zucchero, Iwasaki, Lewis, Lee, & Robbins, 2014). The training model utilized by Zucchero et al. (2011, 2010, 2014) will be described in greater detail in the method section. The most similar model was described by Hadjistavropoulos et al. (2015). Students participated in a one-day IPE pain management workshop that included two keynote presentations, two case presentations by patients, small interprofessional group case discussions, and large group discussions. Students from psychology, nursing, kinesiology, medicine, pharmacy, physical therapy (PT), and social work participated. Wellmon et al. described the implementation of a “6-hour discussion- and case-based learning module” (Wellmon et al., 2012, p. 27). The module took place in three sessions: two, one-hour sessions, and one, four-hour session. The unit included discussion about interdisciplinary practice, introduction of a clinical case of a child with cerebral palsy, a student-led simulated team conference in which a service plan was created for the client, and group processing of the training experience. Graduate students from clinical psychology, education, PT, and social work participated. Finally, the interprofessional educational experience described by Howell et al. (2012) involved occupational therapy (OT) and psychology graduate students who planned and implemented a weekly social skills training program for children with autism spectrum disorder.
The current study contributes to the literature by describing psychology student involvement in IPE with a geropsychology focus and examining psychology student outcomes of that training. Based upon previous research (Zucchero et al., 2010, 2011, 2014), the author hypothesized that psychology students would self-report more positive attitudes toward healthcare teams and greater team skills, after completion of a brief, interprofessional teaming (IPT) training.
Method
Participants
Third or fourth year clinical psychology (Psy.D.) graduate students (
Instruments
Student attitudes about healthcare teams were assessed by the Attitudes Toward Health Care Teams Scale (ATHCTS; Heinemann, Schmitt, Farrell, & Brallier, 1999). This scale is a 20-item self-report measure, with 6-point, Likert-type responses ranging from strongly agree to strongly disagree (0 to 5); negatively worded items are reverse scored. The Cronbach’s α for the ATHCTS pre-test was 0.82, which is good, and for the posttest was 0.78, which is acceptable. The ATHCTS includes two subscales. The 14-item Quality of Care/Process subscale assesses attitudes toward the quality of care provided by healthcare teams and quality of teamwork necessary to achieve this. Scores range from 0 to 70 with higher sores indicating the perception of high quality of care and process from healthcare teams. The Cronbach’s α for the pretest and posttest were both 0.88, which is good. The six-item Physician Centrality subscale measures attitudes toward shared leadership on the team. Scores range from 0 to 30 with higher scores indicating a positive view of physician authority on the team. Cronbach’s α was 0.55 for the pretest and 0.38 for the posttest, indicating poor internal consistency reliability. Item eight negatively affected the Cronbach’s α; with this item deleted, the Cronbach’s α increased to 0.69 for the pretest and 0.62 for the posttest. Due to inadequate reliability, the author will limit further consideration of this subscale.
Students also completed the Team Skills Scale (TSS; Fulmer & Hyer, 1998), a 17-item self-report measure of team skills necessary for geriatric health professionals, including interpersonal, discipline-specific, and geriatric-care skills. Five-point, Likert-type responses for the TSS vary from poor to excellent (1 to 5). Total scores range from 17 to 85; higher scores indicate a higher level of self-reported team skills. The Cronbach’s α for the TSS pretest was 0.92 and posttest was 0.97, which are both considered good.
Procedures
The University’s Institutional Review Board approved this study as exempt. The consent document indicated that participation was voluntary and students could choose not to answer any or all questions. Students completed pretests one month before the training, prior to any preparation, and completed posttests immediately after the training. Students completed the ATHCTS each year, whereas students who participated from 2011–2016 also completed the TSS. The data utilized for this article can be accessed by contacting the author.
The first symposium occurred in the spring of 2009 and is now an annual event. Ongoing planning facilitates pedagogical and logistical improvements. Starting in 2009, undergraduate students in social work and nursing, master’s students in Health Services Administration (HSA), nursing, and OT, and clinical psychology doctoral students attended. Master’s level counseling students joined in 2010. In 2013, the planning committee invited medical and graduate-level PT students from another local university to participate. In 2014, graduate-level PT students from a second local university attended. The number of student attendees varied each year, from 100 in 2011 to 230 in 2013.
Prior to the symposium, all students reviewed a common reading by Slone (2002) about the importance of IP team treatment of older adults who experience dementia and depression and considered their team’s case from their discipline’s perspective. Starting in 2013, students also received a description of each discipline’s practice role to increase familiarity with other disciplines. The case(s) varied from year to year, in terms of number and content. Psychology students also prepared for the IPT experience by reviewing discipline-specific readings (e.g., Slone & Gleason, 1999; Zarit & Zarit, 2007) and participating in lectures/discussions about applicable topics (e.g., psychological consultation; professional practice in geropsychology; related psychopathology, such as delirium and dementia; and caregiving). Students considered the case(s) in class, including case conceptualization, psychologist’s role, and the type of consultation or intervention. The instructor emphasized the importance of IP functioning as a key competency of psychologists working with older adults (APA, 2014; Karel et al., 2012). In 2012, the instructor integrated core the College of Social Sciences, Health, and Education IP competencies for healthcare professionals (IPEC, 2011) into the psychology student experience, including roles/responsibilities for collaborative practice, IP communication, and IP teamwork and team-based care. The use of these competencies served to focus student symposium preparation and involvement.
During the symposium, primary emphasis was placed on the teaming exercise which was structured to facilitate IP team work and highlight the contribution of each discipline. Eight to 12 students from diverse disciplines (i.e., HSA, nursing, social work, OT, PT and psychology) were assigned to teams. The team composition varied across teams. Psychology students typically served as consultants to two or three teams, distributing their time among those teams and simulating the role of a psychologist acting as a consultant to IP teams. Teams also included a faculty facilitator and community partner who was knowledgeable about dementia care, although these professionals were not actively involved in the teaming process. The faculty facilitator redirected the team process only as necessary and the community partner provided information only when needed.
Teams received an agenda for the teaming process including introduction of team members, dialogue about team roles, and discussion of the case from the perspective of each discipline. Teams developed a plan of action and recommendations for their case. Beginning in 2013, teams received a supplementary report form to complete during the teaming process. Team members shared their opinions about the patient’s problems and strengths, and the team prioritized the problems and goals. Members provided feedback about potential solutions, summarized the treatment plan and distribution of tasks across team members, and established a plan for follow-up. Completing the report form increased the structure of the teaming process and the teams’ accountability. Teams also reflected on their process, including team strengths and barriers, what might have made their process more effective and additional resources or information that might have been helpful to facilitate the process. The symposium concluded with processing of the teaming experience among all present, facilitated by the keynote speaker. After the symposium, psychology students reflected on their experience in writing, assessing their strengths and weaknesses, and the functioning of the teams with which they consulted.
Results
A paired-samples
Discussion
HSPEC (2013) affirmed psychologists as health service providers and identified interprofessionalism as a key element of several health service competencies, including professionalism, interpersonal skills and communication, consultation, and interdisciplinary/interprofessional systems. Rozensky noted that professional psychology “must embrace” interprofessionalism “to be successful in the patient-centered, interprofessionally integrated, team-based health care system” (Rozensky, 2012, p. 711). In 2016, the APA joined the IPEC, confirming the importance of interprofessional collaboration to the field of psychology. Stricker (2016) identified the development of programs that prepare psychology students to be part of interdisciplinary treatment teams as an important trend of the future. Many healthcare professionals lack formal training in team-based care and may not be prepared to successfully engage in this important health service competency (Nash et al., 2013). Hence, it is important that effective training models are developed to encourage growth of positive attitudes about interprofessionalism and facilitate the development of interprofessional competencies for psychologists in training.
The brief, IPT case-based training described in this article may positively impact self-reported psychology student attitudes about healthcare teams and ability to work in IP teams. Self-reported attitudes toward healthcare teams were significantly more positive after the symposium which was indicative of a large effect. Therefore, the current results are consistent with review studies indicating IPE can positively impact attitudes about team care (Lapkin et al., 2013; Reeves et al., 2010a; Reeves et al., 2012). Self-reported skills to work effectively in teams, as measured by the TSS, also increased significantly from pretest to posttest, reflecting a robust effect. These results are consistent with review studies indicating IPE can positively influence skills required to provide team care (Hammick et al., 2007; Reeves et al., 2010a). Often, IPE involves a semester long commitment or more; this longer duration may not be necessary to yield more positive attitudes about healthcare teams and perceived team skills. Hence, a brief experience may facilitate the development key competencies for psychology students who are likely to function as HSPs and/or as geropsychologists.
Lapkin et al. (2013) questioned the generalizability of the results of the studies included in their review of IPE, due to the small number of studies and heterogeneity of the interventions. Likewise, Reeves et al. (2010b) noted limited generalizable evidence for the effects of IPE. The current paper extends a line of research about a brief, IPE experience (Zucchero et al., 2011, 2010, 2014). It may not be possible to exactly replicate this IPE experience due to differences across institutions, but a comparable experience may be possible.
There are limitations of the current study. The methodology did not include a control group. The convenience sample was small, and participants were primarily female and Caucasian. The Cronbach’s α for ATHCTS Physician Centrality subscale was low; future studies may further consider the psychometric properties of this sub-scale. The study outcomes were based solely on student self-report. Finally, the use of an immediate posttest did not assess the longevity of the change in self-reported attitudes and ability to work in teams, which speaks to the need for research on more distal outcomes of IPE.
Future research could improve upon the weaknesses of the current study. As previous researchers have noted, generalizability of IPE interventions may be limited (Lapkin et al., 2013; Reeves et al., 2010b). To overcome this limitation, future researchers might implement IPE based upon the model described in this study across universities or training programs. Moreover, future research that includes a control group would strengthen the research design and increase confidence in the results, should differences between the control and intervention groups be found. Finally, the current study measured outcomes based solely on participant self-report. As the field of psychology moves toward competency-based assessment, use of more objective or observational assessment, in addition to self-report, would strengthen the research design.
In conclusion, this paper describes the psychology student experience of a brief, IP team training, which may serve as a model for psychology programs seeking to expose students to IP, case-based learning. Recent models for professional practice in psychology identify interprofessionalism as a necessary competency for psychologists who function as HSPs (HSPEC, 2013; McDaniel et al., 2014; Nash et al., 2013; Rosenzky, 2014) and geropsychologists (APA, 2014; Karel et al., 2012). Many professionals do not receive formal training to develop the attitudes and skills to effectively work across disciplines. Hence, a brief training may facilitate positive attitudes about IP teams and development of skills necessary to work in IP teams.
Footnotes
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by a Summer Fellowship provided by Xavier University.
