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Students’ Perceptions of Roles on a Health Care Team
                                                                                                                                                   Jennifer Young, Pamela Grudzinski, and Joanna Ueng


                                                                                                                           Research Question

Methods                                                                                                                                                    Does a single inter-professional learning activity with a standardized patient (SP) enhance                                                 Discussion
                                                                                                                                                                  health science students’ understanding of roles on a health care team?
Participants: The researchers had intended to recruit two final year students in each of                                                                                                                                                                                                               Preliminary results, based on focus group data, indicate that the participants’
Medicine, Nursing, Occupational Therapy (OT), and Physical Therapy (PT). Recruitment                                                                                                                                                                                                                   understanding of roles on a health care team was enhanced through a single inter-
challenges resulted in fewer participants than was ideal. Participants were divided into                                                                                                                                                                                                               professional learning activity with a SP. Yet, upon completion of the team learning
two groups, as described in Table 1.                                                                                                                                                                                                                                                                   activity, most participants reported that they “didn’t really have much new learning”
                                                                                                                            Preliminary Results
                                                                                                                                                                                                                                                                                                       about professional roles. This contrast may be related to a number of factors
                                 Table 1. Inter-Professional Team Composition                                               Three main themes emerged from the focus group data. These themes, and the relationships between them, are shown in Figure 1.                                              including limited time for reflection prior to the focus group, the participants’
                     Medicine                      Nursing                     OT                          PT                                                                                                                                                                                          backgrounds in IPE, and the participants’ assumptions that increased role knowledge
  Group 1         not represented                  year 4/4                  year 2/2                   year 2/2            Value of the Standardized Patient                                                                                                                                          should be general rather than scenario-specific.
  Group 2             year 2/4                     year 3/4                  year 2/2               not represented         All participants were enthusiastic about the team interaction with the SP. It was expressed that involvement with a SP made the activity
                                                                                                                                                                                                                                                                                                       To enhance general understanding of professional roles, the participants suggested
                                                                                                                            more meaningful: “I definitely don’t get the same thing out of reading a case study...” Three sub-themes were identified.                                                  that they would benefit from a series of inter-professional team activities focusing on
Learning Activity: Both inter-professional learning sessions were held in the Glaxo                                         Realism: “I love doing stuff that’s real!”                                                                                                                                 different case scenarios. Although there is debate in the literature regarding the
Wellcome Clinical Education Centre at Queen’s University. Group 1 attended in the                                           Participants felt that the interaction with the SP increased the applicability of the learning activity to their future practice and made the situation feel clinically    optimal timing for IPE, all participants in this study arrived at a common conclusion.
morning, while Group 2 participated in the afternoon. Both groups received lunch,                                           relevant. One participant also said that talking to the SP as a team was important because it provided an opportunity to differentiate between personality traits          They felt that IPE aiming to enhance students’ understanding of professional roles
although Group 2 ate lunch before beginning the learning activity. A rapport developed                                      and professional roles.                                                                                                                                                    should occur during the later years of professional training. As articulated by one
among the members of the second group during this informal discussion period, which                                                                                                                                                                                                                    participant in her final year of study, “if this had been much earlier, I would have been
was not observed in Group 1. A summary of the learning activity and data collection                                         Patient Leadership: “the patient was the one that was guiding us...”                                                                                                       a bit more nervous about my part... I wouldn’t want to expose that I don’t know a
methods can be found in Table 2.                                                                                            Group 2 applied prior learning about patient-centred care to the organization of their interaction with the SP. Asking the SP to identify her issues of concern            lot...” Participants’ knowledge of and confidence in their own role may be integral to
                                                                                                                            focused the team’s discussion, helping to clarify discipline-specific roles.                                                                                               the success of an initiative that aims to increase students’ understanding of
         Table 2. Outline of the Inter-Professional Learning Activity and Data Collection Methods
                                                                                                                            Communication Skills: “if you have a SP, then we learn how to communicate with the patient as well.”                                                                       professional roles.
  Learning Activity                                                                                  Method of Data
                                 Task                         Rationale for the Task                                        One participant said that she will be able to apply what she learned in terms of “what [other professions] have to say and their ideas...” She added that                  Team-based interaction with a SP was a highly valued, novel learning experience for
    Component                                                                                          Collection
                                                                                                                            interaction with the SP promoted learning of communication skills with patients as well as team members.                                                                   all of the participants. The preliminary results suggest that enthusiasm for the
                      - complete pre-learning       - establish participants' baseline
    questionnaire                                                                                - questionnaire (paper)
                      activity questionnaire        understanding of roles                                                                                                                                                                                                                             learning activity was generated primarily through the interaction with the SP.
                      - read case scenario
                                                    - individuals become familiar with the                                                                                                                                                                                                             Participants believed that the SP contributed to a more realistic learning environment,
                                                    case scenario                                                                                                                                                                                                                                      increased the challenge and complexity of the learning activity, and allowed them to
                                                    - team determines issues to address                                                                                                                                                                                                                create meaning from the case scenario. Clinical relevance was also enhanced
     team-based      - discuss scenario with        with the SP                                  - videotape                                                                                                                                    COMPLEMENTARY
                                                                                                                                                                 REALISM                                                                            ROLES
                                                                                                                                                                                                                                                                                                       through interaction with the SP as a result of her responsiveness to each team’s
   learning activity team                           - team plans their approach to the SP        - audiotape
                                                    interaction
                                                                                                                                                                                                                                                                                                       approach. Teams were able to organize and carry out the learning activity in a way
                                                                                                                                                                                   VALUE OF THE                         COMPREHENSIVE                                                                  that incorporated the patient’s voice. A patient-centred approach may be difficult to
                      - team interaction with       - team and SP address health issues of                                                                    PATIENT                                                                                    ROLE
                                                                                                                                                            LEADERSHIP                  SP                               PATIENT CARE                   OVERLAP                                        apply to a non-interactive case scenario. Interaction with the SP facilitated a deeper
                      the SP                        concern
                      - complete post-activity      - record changes in participants'                                                                                                                                                                                                                  exploration of the issues raised in the case scenario, which contributed to
    questionnaire                                                                                - questionnaire (paper)                                                                                                                          ROLE
                      questionnaire                 understanding of roles                                                                                       COMMUNICATION
                                                                                                                                                                                                                                               APPRECIATION
                                                                                                                                                                                                                                                                                                       participants’ insights into the complexity of roles in an inter-professional health care
                                                                                                                                                                    SKILLS
                                                    - gain insight into participants' learning                                                                                                                                                                                                         team.
                      - participate in the post-    and perception of roles                      - videotape
    focus group
                      activity focus group          - exchange feedback about the                - audiotape                                                                                        CONTEXT-SPECIFIC
                                                    learning activity                                                                                                                                  LEARNING
                                                                                                                                                                                                                                                                                                      Acknowledgments
Data Analysis: Each focus group and learning activity was transcribed verbatim from the                                                                                      Figure 1. Interconnected themes and sub-themes that emerged                                                              We would like to thank the staff of the Glaxo Wellcome Clinical Education Centre,
audiotapes. Transcripts were individually hand-coded by the three researchers. The                                                                                                     from data collected during the focus groups.                                                                   including Cathy Hollington, for their assistance in developing and implementing our
codes were grouped into themes and sub-themes according to the relationships                                                                                                                                                                                                                          learning activities. We would also like to acknowledge the guidance that Debbie
between them, following agreement of the researchers.                                                                                                                                                                                                                                                 Docherty, Anne O’Riordan and Dr. Margo Patterson have provided throughout the
                                                                                                                            Comprehensive Patient Care                                                                                                                                                research process.
                                                                                                                            Participants believed that engaging in a clinical scenario as an inter-professional team allowed them to “really see how it all fits                                      Support for this research was provided in part through student stipends from QUIPPED
                                                                                                                            together...” Three sub-themes were identified.                                                                                                                            (Queen’s University Inter-Professional Patient-Centred Education Direction).
Background Information                                                                                                      Complementary Roles: “if you don’t have an answer, somebody else will... you’re supporting each other...”
When working with patients with complex health problems, the skills and knowledge of                                        Participants agreed that working as a team with the SP enabled them to find multiple solutions to common issues of concern. They reported interest in
several professionals are frequently required to address issues that surpass the scope of                                   learning about treatment approaches used by members of different disciplines.
any single profession.1, 2 Members of effective inter-professional teams typically                                                                                                                                                                                                                    References
demonstrate clear understanding of their colleagues’ professional roles, and appreciate the                                 Role Overlap: “[others’ roles] don’t just get forgotten, but other people will absorb them...”
                                                                                                                                                                                                                                                                                                      1. Parsell, G., Spalding, R., & Bligh, J. (1998). Shared goals, shared learning: Evaluation of a
skills and knowledge that members of other disciplines contribute to patient care.3                                         All participants noted the effect of team composition on professional roles within a health care team. Some participants reported new learning about roles that                  multiprofessional course for undergraduate students. Medical Education, 32, 304-311.
                                                                                                                            can be filled by multiple disciplines, while others increased their understanding of the nuances associated with shared professional roles.
Since graduates of professional programs are expected to be able to function effectively                                                                                                                                                                                                              2. Lumague, M., Morgan, A., Mak, D., Hanna, M., Kwong, J., Cameron, C., Zener, D., & Sinclair, L. (2006).
within a team-based health care environment, inter-professional education (IPE) initiatives                                 Role Appreciation: “the OT sees something completely different from what I saw...”                                                                                              Interprofessional education: The student perspective. Journal of Interprofessional Care, 20(3),
are being developed at a pre-licensure level. Problem-based inter-professional learning                                     One participant expressed that an intra-professional approach hinders patient care by de-emphasizing the knowledge, skills, and perspectives that                               246-253.
methods facilitate the development of effective team skills while integrating the knowledge                                 professionals from other disciplines can provide. Participants recognized that each discipline offers a unique perspective on a patient’s situation.
base of multiple health care disciplines into the learning activity.3                                                                                                                                                                                                                                 3. Curran, V. R., Mugford, J. G., Law, R. M. T., & MacDonald, S. (2005). Influence of an interprofessional
                                                                                                                                                                                                                                                                                                             HIV/AIDS education program on role perception, attitudes and teamwork skills of undergraduate
Adult learners respond most positively to IPE when they perceive a direct relevance                                                                                                                                                                                                                          health science students. Education for Health, 18(1), 32-44.
between the learning activity and their current or future practice.1 The realism of an IPE                                  Context-Specific Learning
                                                                                                                            In terms of discipline-specific roles on a health care team, many participants expressed that the learning activity “just reiterated what I                               4. Westberg, S. M., Adams, J., Thiede, K., Stratton, T. P., & Bumgardner, M. A. (2006). Innovations in
experience can be enhanced by using a simulated clinical environment and/or a SP.1, 4                                                                                                                                                                                                                        teaching: An interprofessional activity using standardized patients. American Journal of
Working through a case scenario that mirrors a real-life situation has the potential to                                     had seen...” during other IPE opportunities. Participants felt that their learning was specific to the scenario: “my thoughts that were                                          Pharmaceutical Education, 70(2), Article 34.
improve communication in student health care teams, allowing members to share                                               different were just basically related to the situation...” Several participants reported learning about new strategies, techniques, or
knowledge with one another about professional roles.4, 5                                                                    resources specific to the clinical scenario from their colleagues.                                                                                                        5. Oandasan, I. & Reeves, S. (2005). Key elements for interprofessional education. Part 1: The learner,
                                                                                                                                                                                                                                                                                                            the educator and the learning context. Journal of Interprofessional Care, Supplement 1, 21-38.

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Students%20perceptions%20of%20roles%20on%20a%20 health%20care%20team

  • 1. Students’ Perceptions of Roles on a Health Care Team Jennifer Young, Pamela Grudzinski, and Joanna Ueng Research Question Methods Does a single inter-professional learning activity with a standardized patient (SP) enhance Discussion health science students’ understanding of roles on a health care team? Participants: The researchers had intended to recruit two final year students in each of Preliminary results, based on focus group data, indicate that the participants’ Medicine, Nursing, Occupational Therapy (OT), and Physical Therapy (PT). Recruitment understanding of roles on a health care team was enhanced through a single inter- challenges resulted in fewer participants than was ideal. Participants were divided into professional learning activity with a SP. Yet, upon completion of the team learning two groups, as described in Table 1. activity, most participants reported that they “didn’t really have much new learning” Preliminary Results about professional roles. This contrast may be related to a number of factors Table 1. Inter-Professional Team Composition Three main themes emerged from the focus group data. These themes, and the relationships between them, are shown in Figure 1. including limited time for reflection prior to the focus group, the participants’ Medicine Nursing OT PT backgrounds in IPE, and the participants’ assumptions that increased role knowledge Group 1 not represented year 4/4 year 2/2 year 2/2 Value of the Standardized Patient should be general rather than scenario-specific. Group 2 year 2/4 year 3/4 year 2/2 not represented All participants were enthusiastic about the team interaction with the SP. It was expressed that involvement with a SP made the activity To enhance general understanding of professional roles, the participants suggested more meaningful: “I definitely don’t get the same thing out of reading a case study...” Three sub-themes were identified. that they would benefit from a series of inter-professional team activities focusing on Learning Activity: Both inter-professional learning sessions were held in the Glaxo Realism: “I love doing stuff that’s real!” different case scenarios. Although there is debate in the literature regarding the Wellcome Clinical Education Centre at Queen’s University. Group 1 attended in the Participants felt that the interaction with the SP increased the applicability of the learning activity to their future practice and made the situation feel clinically optimal timing for IPE, all participants in this study arrived at a common conclusion. morning, while Group 2 participated in the afternoon. Both groups received lunch, relevant. One participant also said that talking to the SP as a team was important because it provided an opportunity to differentiate between personality traits They felt that IPE aiming to enhance students’ understanding of professional roles although Group 2 ate lunch before beginning the learning activity. A rapport developed and professional roles. should occur during the later years of professional training. As articulated by one among the members of the second group during this informal discussion period, which participant in her final year of study, “if this had been much earlier, I would have been was not observed in Group 1. A summary of the learning activity and data collection Patient Leadership: “the patient was the one that was guiding us...” a bit more nervous about my part... I wouldn’t want to expose that I don’t know a methods can be found in Table 2. Group 2 applied prior learning about patient-centred care to the organization of their interaction with the SP. Asking the SP to identify her issues of concern lot...” Participants’ knowledge of and confidence in their own role may be integral to focused the team’s discussion, helping to clarify discipline-specific roles. the success of an initiative that aims to increase students’ understanding of Table 2. Outline of the Inter-Professional Learning Activity and Data Collection Methods Communication Skills: “if you have a SP, then we learn how to communicate with the patient as well.” professional roles. Learning Activity Method of Data Task Rationale for the Task One participant said that she will be able to apply what she learned in terms of “what [other professions] have to say and their ideas...” She added that Team-based interaction with a SP was a highly valued, novel learning experience for Component Collection interaction with the SP promoted learning of communication skills with patients as well as team members. all of the participants. The preliminary results suggest that enthusiasm for the - complete pre-learning - establish participants' baseline questionnaire - questionnaire (paper) activity questionnaire understanding of roles learning activity was generated primarily through the interaction with the SP. - read case scenario - individuals become familiar with the Participants believed that the SP contributed to a more realistic learning environment, case scenario increased the challenge and complexity of the learning activity, and allowed them to - team determines issues to address create meaning from the case scenario. Clinical relevance was also enhanced team-based - discuss scenario with with the SP - videotape COMPLEMENTARY REALISM ROLES through interaction with the SP as a result of her responsiveness to each team’s learning activity team - team plans their approach to the SP - audiotape interaction approach. Teams were able to organize and carry out the learning activity in a way VALUE OF THE COMPREHENSIVE that incorporated the patient’s voice. A patient-centred approach may be difficult to - team interaction with - team and SP address health issues of PATIENT ROLE LEADERSHIP SP PATIENT CARE OVERLAP apply to a non-interactive case scenario. Interaction with the SP facilitated a deeper the SP concern - complete post-activity - record changes in participants' exploration of the issues raised in the case scenario, which contributed to questionnaire - questionnaire (paper) ROLE questionnaire understanding of roles COMMUNICATION APPRECIATION participants’ insights into the complexity of roles in an inter-professional health care SKILLS - gain insight into participants' learning team. - participate in the post- and perception of roles - videotape focus group activity focus group - exchange feedback about the - audiotape CONTEXT-SPECIFIC learning activity LEARNING Acknowledgments Data Analysis: Each focus group and learning activity was transcribed verbatim from the Figure 1. Interconnected themes and sub-themes that emerged We would like to thank the staff of the Glaxo Wellcome Clinical Education Centre, audiotapes. Transcripts were individually hand-coded by the three researchers. The from data collected during the focus groups. including Cathy Hollington, for their assistance in developing and implementing our codes were grouped into themes and sub-themes according to the relationships learning activities. We would also like to acknowledge the guidance that Debbie between them, following agreement of the researchers. Docherty, Anne O’Riordan and Dr. Margo Patterson have provided throughout the Comprehensive Patient Care research process. Participants believed that engaging in a clinical scenario as an inter-professional team allowed them to “really see how it all fits Support for this research was provided in part through student stipends from QUIPPED together...” Three sub-themes were identified. (Queen’s University Inter-Professional Patient-Centred Education Direction). Background Information Complementary Roles: “if you don’t have an answer, somebody else will... you’re supporting each other...” When working with patients with complex health problems, the skills and knowledge of Participants agreed that working as a team with the SP enabled them to find multiple solutions to common issues of concern. They reported interest in several professionals are frequently required to address issues that surpass the scope of learning about treatment approaches used by members of different disciplines. any single profession.1, 2 Members of effective inter-professional teams typically References demonstrate clear understanding of their colleagues’ professional roles, and appreciate the Role Overlap: “[others’ roles] don’t just get forgotten, but other people will absorb them...” 1. Parsell, G., Spalding, R., & Bligh, J. (1998). Shared goals, shared learning: Evaluation of a skills and knowledge that members of other disciplines contribute to patient care.3 All participants noted the effect of team composition on professional roles within a health care team. Some participants reported new learning about roles that multiprofessional course for undergraduate students. Medical Education, 32, 304-311. can be filled by multiple disciplines, while others increased their understanding of the nuances associated with shared professional roles. Since graduates of professional programs are expected to be able to function effectively 2. Lumague, M., Morgan, A., Mak, D., Hanna, M., Kwong, J., Cameron, C., Zener, D., & Sinclair, L. (2006). within a team-based health care environment, inter-professional education (IPE) initiatives Role Appreciation: “the OT sees something completely different from what I saw...” Interprofessional education: The student perspective. Journal of Interprofessional Care, 20(3), are being developed at a pre-licensure level. Problem-based inter-professional learning One participant expressed that an intra-professional approach hinders patient care by de-emphasizing the knowledge, skills, and perspectives that 246-253. methods facilitate the development of effective team skills while integrating the knowledge professionals from other disciplines can provide. Participants recognized that each discipline offers a unique perspective on a patient’s situation. base of multiple health care disciplines into the learning activity.3 3. Curran, V. R., Mugford, J. G., Law, R. M. T., & MacDonald, S. (2005). Influence of an interprofessional HIV/AIDS education program on role perception, attitudes and teamwork skills of undergraduate Adult learners respond most positively to IPE when they perceive a direct relevance health science students. Education for Health, 18(1), 32-44. between the learning activity and their current or future practice.1 The realism of an IPE Context-Specific Learning In terms of discipline-specific roles on a health care team, many participants expressed that the learning activity “just reiterated what I 4. Westberg, S. M., Adams, J., Thiede, K., Stratton, T. P., & Bumgardner, M. A. (2006). Innovations in experience can be enhanced by using a simulated clinical environment and/or a SP.1, 4 teaching: An interprofessional activity using standardized patients. American Journal of Working through a case scenario that mirrors a real-life situation has the potential to had seen...” during other IPE opportunities. Participants felt that their learning was specific to the scenario: “my thoughts that were Pharmaceutical Education, 70(2), Article 34. improve communication in student health care teams, allowing members to share different were just basically related to the situation...” Several participants reported learning about new strategies, techniques, or knowledge with one another about professional roles.4, 5 resources specific to the clinical scenario from their colleagues. 5. Oandasan, I. & Reeves, S. (2005). Key elements for interprofessional education. Part 1: The learner, the educator and the learning context. Journal of Interprofessional Care, Supplement 1, 21-38.