Abstract
It is well recognized in clinical practice that the delivery of high-quality and safe healthcare services requires interprofessional (IP) collaboration (IPC), where a multidisciplinary team works in a collaborative and integrated manner to achieve optimal health outcomes.1,2
Whilst the importance of IP education (IPE) is widely accepted however, many healthcare educators are struggling to measure specific clinical outcomes of these learning activities, in addition to qualitative accounts of better knowledge and understanding of the team members. 3 The need to motivate and drive the teaching and learning in IP teams remains an enigma. Given the increasing emphasis on IPE, IP assessment (IPA) is beginning to draw attention as an essential, albeit challenging component in IPE. To date, there has been no consensus on IPA in the literature in terms of IPE outcomes and the assessment techniques to be employed. 4 This situation is largely attributable to the complex and multifaceted nature of healthcare services and outcomes.
Benefits of IPA
“Assessment drives learning” is a well-known adage that is also applicable for IPE. Often what is missing in an IPE program is the measurement of the team and each member’s contribution to the achievement of the patient’s outcome. Without assessment, it will be difficult to ensure that learning has occurred, and that the IPE module has been successfully taught and learnt.
1) document and measure learners’ progress related to their IPE learning journey;
2) give more details of and insights on team members’ learning experience;
3) provide feedback on effectiveness of teaching strategies;
4) enable team members to reflect on objectives and expectations of the program.
It is not surprising that many healthcare professionals deem IPE to have a lower status than their profession-specific learning. This perception would hamper learners’ engagement in and commitment to IPE. To help eliminate the negative effects of this stereotyping, IPA can serve as an avenue to convey the significance of IPE to all stakeholders and give IPE equal weight to profession-specific education.
Challenges to IPA
As described above, there are many different types of learning approaches employed in IPE which require us to clearly define the corresponding constituent elements in assessment, in order to inform educators and learners of their collaborative performance. This is quite challenging as different assessment methods need to be identified to match the various learning approaches. Challenges faced in IPA can be summarized as follows.
1. Academic versus clinical settings
There is a variety of IP, multidisciplinary, and transdisciplinary teams, all of which function very differently in the clinical environment depending on the clinical operative setup. Assessment for team members in each of the different IP collaborative practices will be different to test the knowledge and skills required in each setting. The academic setting also struggles to provide IP learning experiences and typically comprises classroom or project teams consisting of various healthcare disciplines learning side by side during a multidisciplinary lecture, or occasionally participating in a multidisciplinary simulation case study in the simulation laboratory.
It is easier in a clinical environment compared to an academic institution, to include nurses and doctors in an IPE team teaching session. Despite this, there is still a struggle to include all team members (especially the many diverse allied health professionals) in either setting. To include all the key healthcare team members for teaching and assessment requires many hours of detailed planning for curriculum, teaching environment and manpower, in addition to the nightmare of synchronizing different student and faculty schedules.
2. Team mix and hierarchy
Often the difficulty in assessing the different healthcare professionals may not be differences in knowledge and competencies possessed, but the difficulty to navigate subtle social or bureaucratic cultural barriers, such as power differential or hierarchical reporting culture that exists in the team. This problem can be found in both in academic and clinical environments.7,8 Team assessment should therefore consider the different roles and responsibilities that each member plays in the team. The matching of team members or team mix in terms of number or the different healthcare professionals needed, their expertise and years of experience, will also affect the teaching and assessment effectiveness of the team. If the gap in knowledge and experience is too wide, these team members may be less participative and that can affect the overall team performance. 8
3. Assessment tools
Whilst there are many assessment tools for specific uniprofessional knowledge and skills, it is difficult to assess the knowledge and competency of different team members in an assessment setting using the typical OSCE or Direct Observation of Procedure. Most studies focus on or are limited to: qualitative formative assessments; multiple choice questions on general knowledge of specific topics required by all team members; and specific team collaborative competencies, such as respect, ethical behavior, communication, etc. Other challenges faced in conducting team IPA are as follows.
Current pedagogical studies are limited to effective summative assessment tools for the IP team in a classroom setting. It is difficult to conduct a summative observation team assessment in a clinical environment unless there are multiple observers or general competencies to be tested. 8
There is the question of whether the team should be graded as a whole or as its constituent individuals.
There is a lack of summative team assessment tools in the literature.
Summary
To ensure an effective IPE, it is important to close the gap between academic and clinical settings and to include an effective IP collaborative practice assessment of the team and its members. An effective IPA model should take into consideration an integrated and multifactorial approach to assess the team structure (made up of individuals), the functions of the team (understanding their roles, responsibilities, and relationships) and clinical outcomes (task completion).