interprofessional relations

Universal health coverage is at the centre of current efforts to strengthen health systems and to improve the level and distribution of health services. It is high on the global and national agendas of many countries, many of which have already made significant progress. The compelling case for universal health coverage derives principally from the values of fairness and equity, and these values are also critical on the path to that goal. If universal coverage cannot be attained immediately, making progress fairly and equitably should be the main concern.

Hazardous waste sites are a priority for local health officers in New Jersey. However, most officers feel that they are not adequately briefed or consulted by federal and state officials who manage site remediation. Consequently, many local health officers tend to be neutral or negative about federal and state site remediation plans. Consultation with local health officers should be formally built into the site remediation process, and officers should directly approach their state governments to gain access.

Background: Advances in information and communication technology are influencing instructional formats and delivery modes for post secondary teaching and learning. Aims: The purpose of this study was to determine whether interprofessional team process skills traditionally taught in a small group face-to-face classroom setting could be taught in a blended learning environment; without compromising the pedagogical approach and collaborative Group Investigation Model (Sharan & Sharan 1992) used in the course. Method: A required interprofessional team development course designed to teach health science students (Medicine, Nursing, Pharmacy, Occupational Therapy, Physical Therapy, Dentistry, Dental Hygiene, Medical Laboratory Science, and Nutrition) team process skills was redesigned from a 100% face-to-face delivery format to a blended learning format where 70% of the instruction was delivered using a new synchronous virtual classroom technology (Elluminate www.elluminate.com) in conjunction with asynchronous technology (WebCT). It was hypothesized there would be no significant difference between the blended learning format and the traditional face-to-face format in the development of interprofessional team knowledge, skills and attitudes. The two formats were evaluated on demographic information, computer experience, and interprofessional team attitudes, knowledge and skills. Results: The three main findings are: (a) no significant differences between student groups on achieving team process skills, (b) an observation of differences between the groups on team dynamics, and (c) a more positive achievement of course learning objectives perceived by students in the blended learning class. Conclusions: The results provide evidence to support our blended learning format without compromising pedagogy. They also suggest that this format enhances students' perceptions of their learning.

The encroachment of conflicts of interest on the peer-review process of scientific journals is discussed, with particular reference to a current example. The authors stress the need for transparency of the connections among authors, reviewers, publishers, editors, and sources of funding to prevent erosion of trust in the scientific integrity of such publications.

Shift handovers occur in many safety-critical environments, including aviation maintenance, medicine, air traffic control, and mission control for space shuttle and space station operations. Shift handovers are associated with increased risk of communication failures and human error. In dynamic industries, errors and accidents occur disproportionately after shift handover. Typical shift handovers involve transferring information from an outgoing shift to an incoming shift via written logs, or in some cases, face-to-face briefings. The current study explores the possibility of improving written communication with the support modalities of audio and video recordings, as well as face-to-face briefings. Fifty participants participated in an experimental task which mimicked some of the critical challenges involved in transferring information between shifts in industrial settings. All three support modalities-face-to-face, video, and audio recordings, reduced task errors significantly over written communication alone. The support modality most preferred by participants was face-to-face communication; the least preferred was written communication alone.

There is lack of literature data reporting an incorporation of medication management reviews in students' interprofessional education and practice programs in aged care settings. This study reports how an interprofessional disease state and medication management review program (DSMMR) was established in a residential aged care facility in Perth, Western Australia. Students from the disciplines of nursing, pharmacy and physiotherapy focused on a 'wellness check' in the areas of cognition, falls and continence whilst integrating a medication management review. Students' attitudes were explored using a pre and post placement questionnaire. Students indicated positive experience with the Interprofessional Professional Education (IPE) DSMMR program which also resulted in their positive attitudinal shift towards interprofessional education and practice. These findings indicated that aged care can be a suitable setting for student interprofessional programs focusing on DSMMR.

Background: Traditional biochemistry teaching often lacks active learning and problem-solving for clinical application. Team-based learning (TBL), with pre-class preparation, individual and team readiness assessments, feedback, and application exercises, provides a structured alternative. Aim: To study the effectiveness of TBL as a strategy for providing clinical relevance in a biochemistry classroom. Methodology: This educational intervention study involved 250 first-year MBBS students in two TBL sessions with a focus on two clinically relevant biochemistry competencies. The preparation phase involved facilitator and student sensitization, team formation, and study tool validation. The sessions were delivered in four practical batches, each divided into eight teams with seven or eight learners. The students' performance was analyzed using their individual and team readiness assessment scores and a one week post-session problem-based assessment (PBA) scores. Feedback was collected from students and facilitators after completion of both sessions using Google Forms. Results: Collaborative learning significantly improved student performance in team readiness assessments compared to individual work. Students demonstrated strong content mastery in clinical problem-solving assessments, expressed confidence in future applications, and recognized the value of basic science in clinical contexts. They also reported improved communication and teamwork skills. Overall, 74% of students achieved a final cumulative TBL score above 70% and 87% of students were satisfied with the learning experience. Conclusions: Team-based learning proved to be an effective and engaging method for teaching clinically relevant biochemistry content. It can be integrated with traditional instructional methods to reinforce learning topics, promote active engagement, and foster collaboration and healthy competition among learners.

Objectives: There have been calls for greater exchange between research and practice in health care policy and management, but little empirical research on what commissioners of research and researchers themselves consider appropriate, good quality research knowledge. This paper addresses this gap, considering the views of commissioners and producers of policy and management research in health care and other fields. Methods: Qualitative semi-structured interviews with 18 commissioners and producers of research, in central government, the NHS and other commissioning organizations, and in universities and independent sector providers. Results: Commissioners and producers agreed that research often fails to fulfil policy-makers’ and managers’ needs, and that greater interaction is required to improve this relationship. However, they offered differing accounts of the nature of research knowledge (as a ‘product’ or a ‘mindset’), and of what constitutes value, validity and originality in ...

We describe and evaluate a project designed to pilot test an evidence-based clinical intervention for assessing and treating depression in older adults in rural primary care clinics. Project ADAPT-Assuring Depression Assessment and Proactive Treatment-utilized existing primary care resources to overcome barriers to sustainability experienced by similar projects. Design and Methods: This multifaceted intervention, which was structured after the successful IMPACT (Improving Mood/ Promoting Access to Collaborative Treatment) research intervention, used on-site geriatric depression specialists, clinic staff training, team collaboration, and depression practice guidelines to improve depression care for rural elders. IMPACT screening and assessment instruments and treatment protocols were modified for use by less highly trained staff already employed by the rural primary care clinics. Patient and provider depression educational materials and depression screening and monitoring protocols were provided by means of regional training sessions and phone contact. Evaluation data were collected by mail and phone surveys. Results: Although Project ADAPT materials and training were initially developed for providers in rural primary care clinics, most participants came from long-term-care facilities, hospitals, home care, and public health and social service agencies. Forty-four sites sent 56 staff to Project ADAPT regional trainings, but many did not participate after the initial training. Participants who did continue reported that training improved geriatric depression screening and communication with the primary provider. Implications: Outcomes suggest that provider, patient, and system issues have to be addressed differently in rural areas to improve geriatric depression treatment in primary care settings.

Background The beryllium lymphocyte proliferation test (BeLPT) is used to identify persons sensitized to beryllium. ATSDR convened an expert panel of physicians and scientists in April 2006 to discuss this test and to consider what BeLPT test results actually establish beryllium sensitization. The three criteria proposed by panel members were (1) one abnormal result, (2) one abnormal and one borderline result, and (3) two abnormal results. Methods Complete algorithms were developed for each of the three proposed criteria. Using single-test outcome probabilities developed by Stange et al. [2004. Am J Ind Med 46:453-462], we calculated and compared the sensitivity, specificity, and positive predictive values (PPVs) for each set of criteria. The overall sensitivity and specificity of the three criteria were similar. When the criteria required confirmation of an abnormal result the PPV was higher-whether the requirement was satisfied by a borderline result, or only by another abnormal result. Confirmation also reduced the likelihood of false positives. The differences between the three criteria decreased as the prevalence of sensitization increased. Conclusions A single unconfirmed abnormal is usually insufficient to establish sensitization for an apparently healthy person. When the prevalence of beryllium sensitization in a group is high, however, even a single abnormal BeLPT can be a strong predictor.

Despite growing evidence of the direct and indirect effects of the built environment on public health, planners, who shape the built environment, and public health professionals, who protect the public's health, rarely interact. Most public health professionals have little experience with urban planners, zoning boards, city councils, and others who make decisions about the built environment. Likewise, few planners understand the health implications of design, land use, or transportation decisions. One strategy for bridging this divide is the development of interdisciplinary courses in planning and public health that address the health implications of the built environment. Professional networking and Internet-based searches in 2007 led to the identification of six primarily graduate-level courses in the U.S. that address the links between the built environment and public health. Common content areas in most of the identified courses included planning and public health histories, health disparities, interdisciplinary approaches, air and water quality, physical activity, social capital, and mental health. Instructors of these courses collaborated on course content, assignments, and evaluations to develop a model curriculum that follows an active learning-centered approach to course design. The proposed model curriculum is adaptable by both planning and public health departments to promote interdisciplinary learning. Results show that students gain planning and public health perspectives through this instruction, benefiting from activelearning opportunities. Faculty implementation of the proposed interdisciplinary model curriculum will help bridge the divide between the built environment and public health and enable both planners and public health professionals to value, create, and promote healthy environments.

Objectives Supplementary prescribing has seen pharmacists assume greater responsibility for prescribing in collaboration with doctors. This study explored the context and experiences, in relation to the practice of supplementary prescribing, of pharmacists and physicians (who acted as their training mentors) at least 12 months after pharmacists had qualified as supplementary prescribers. Methods The setting was primary and secondary healthcare sectors in Northern Ireland. Pharmacists and mentors who had participated in a pre-training study were invited to take part. All pharmacists (n = 47) were invited to participate in focus groups, while mentors (n = 35) were asked to participate in face-to-face semi-structured interviews. The research took place between May 2005 and September 2007. All discussions and interviews were audiotaped, transcribed and analysed using constant comparison. Key findings Nine pharmacist focus groups were convened (number per group ranging from three to six; total n = 40) and 31 semi-structured interviews with mentors were conducted. The six main themes that emerged were optimal practice setting, professional progression for prescribing pharmacists, outcomes for prescribing pharmacists, mentors and patients, relationships, barriers to implementation and the future of pharmacist prescribing. Where practised, pharmacist prescribing had been accepted, worked best for chronic disease management, was perceived to have reduced doctors' workload and improved continuity of care for patients. However, three-quarters of pharmacists qualified to practise as supplementary prescribers were not actively prescribing, largely due to logistical and organisational barriers rather than inter-professional tensions. Independent prescribing was seen as contentious by mentors, particularly because of the diagnostic element. Conclusions Supplementary prescribing has been successful where it has been implemented but a number of barriers remain which are preventing the wider acceptance of this practice innovation.

Objectives Supplementary prescribing has seen pharmacists assume greater responsibility for prescribing in collaboration with doctors. This study explored the context and experiences, in relation to the practice of supplementary prescribing, of pharmacists and physicians (who acted as their training mentors) at least 12 months after pharmacists had qualified as supplementary prescribers. Methods The setting was primary and secondary healthcare sectors in Northern Ireland. Pharmacists and mentors who had participated in a pre-training study were invited to take part. All pharmacists (n= 47) were invited to participate in focus groups, while mentors (n= 35) were asked to participate in face-to-face semi-structured interviews. The research took place between May 2005 and September 2007. All discussions and interviews were audiotaped, transcribed and analysed using constant comparison. Key findings Nine pharmacist focus groups were convened (number per group ranging from three to six; t...

A comprehensive discussion of professionalism in medicine must include its impact on successive generations of physicians. Fifty years ago, doctors acting professionally emphasized medicine as a calling and an ability to act as the authority for patients in crisis at home and in hospitals.Therapeutic options were limited relative to the modern era, and the laying on of hands was practiced as science and art. Today, doctors balance increasing demands on time and efficiency with the sense of primacy of patient care.Technological innovation and patients' increasing access to medical knowledge through varying media of inconsistent quality challenge physicians in novel ways. Fifty years in the future, doctors will have access to vast amounts of information through a multitude of noninvasive diagnostics. Progressively more personalized medicine should inspire doctors to become even more adept at communicating effectively with patients. Professionalism in medicine throughout these generations embodies similar fundamental behaviors, such as demonstrating compassion, respect, and humility; adhering to high ethical and moral standards; subordinating personal interest to that of others; and reflecting on actions and decisions. Despite the dynamic nature of the profession itself, the omnipresent need for such traits will define medical professionalism for decades to come. U NDERSTANDING PROFESSIONALISM in modern medicine occupies a great deal of attention in medical education, research, and practice. A universally recognized definition eludes the profession, but professionalism itself may be considered in the context of the era in which it applies.This exploration of pro-

Background:Interactions between the pharmaceutical industry (PI) and psychiatrists have been under scrutiny recently, though there is little empirical evidence on the nature of the relationship and its intensity at psychiatry trainee level. We therefore studied the level of PI interactions and the underlying beliefs and attitudes in a large sample of European psychiatric trainees.Methods:One thousand four hundred and forty-four psychiatric trainees in 20 European countries were assessed cross-sectionally, with a 62-item questionnaire.Results:The total number of PI interactions in the preceding two months varied between countries, with least interactions in The Netherlands (M (Mean) = 0.92, SD = 1.44, range = 0–12) and most in Portugal (M = 19.06, SD = 17.44, range = 0–100). Trainees were more likely to believe that PI interactions have no impact on their own prescribing behaviour than that of other physicians (M = 3.30, SD = 1.26 vs. M = 2.39, SD = 1.06 on a 5-point Likert scale: 1 ...

Background: National statistics reveal that efforts to reduce medical student mistreatment have been largely ineffective. Some hypothesize that as supervisors gain skills in professionalism, medical students become more sensitive. Aims: The purpose of this study was to determine if medical student perceptions of mistreatment are correlated with mistreatment sensitivity. Method: At the end of their third year, 175 medical students completed an Abuse Sensitivity Questionnaire, focused on student assessment of hypothetical scenarios which might be perceived as abusive, and the annual Well-Being Survey, which includes measurement of incident rates of mistreatment. It was hypothesized that those students who identified the scenarios as abusive would also be more likely to perceive that they had been mistreated. Results: Student perceptions of mistreatment were not statistically correlated with individual's responses to the scenarios or to a statistically derived abuse sensitivity variable. There were no differences in abuse sensitivity by student age or ethnicity. Women were more likely than men to consider it ''harsh'' to be called incompetent during rounds ( p 5 0.0005). This study provides preliminary evidence that challenges the hypothesis that medical students who perceive mistreatment by their superiors are simply more sensitive.

Background: Healthcare professionals perform knowledge-intensive work in very specialized disciplines. Across the professional divide, collaboration becomes increasingly difficult. For effective teamwork and collaboration to occur, it is considered necessary for individuals to believe in their ability to draw on their expertise and provide what others need to perform their job well. To date, however, no instruments exist to measure such a construct. Methods: A two-study design is used to test the psychometric properties, factor structure and incremental validity of a five-item questionnaire measuring informational role self-efficacy. Results: Based on parallel analysis and exploratory factor analysis, Study 1 shows a robust and reliable onedimensional construct. Study 2 cross-validates this factor structure using confirmatory factor analysis. Study 2 also shows that informational role self-efficacy predicts proactive teamwork behaviors over and above goal similarity, interdependence, coordination and intra-team trust. Conclusions: The instrument can be used in research to assess an individual's capability beliefs in communicating his/her informational characteristics that are pertinent to the task performance of others. The construct is also shown to have value in team-building exercises.

Background: Healthcare professionals perform knowledge-intensive work in very specialized disciplines. Across the professional divide, collaboration becomes increasingly difficult. For effective teamwork and collaboration to occur, it is considered necessary for individuals to believe in their ability to draw on their expertise and provide what others need to perform their job well. To date, however, no instruments exist to measure such a construct. Methods: A two-study design is used to test the psychometric properties, factor structure and incremental validity of a five-item questionnaire measuring informational role self-efficacy. Results: Based on parallel analysis and exploratory factor analysis, Study 1 shows a robust and reliable onedimensional construct. Study 2 cross-validates this factor structure using confirmatory factor analysis. Study 2 also shows that informational role self-efficacy predicts proactive teamwork behaviors over and above goal similarity, interdependence, coordination and intra-team trust. Conclusions: The instrument can be used in research to assess an individual's capability beliefs in communicating his/her informational characteristics that are pertinent to the task performance of others. The construct is also shown to have value in team-building exercises.