Assessing teams instead of individuals

Patient outcomes are almost always influenced by how well the team works together, yet all of the disciplines conduct assessments of individual students. Yes, we might ask students who they would refer to, or who else is important in the management of the patient, but do we ever actually watch a student talk to a nurse, for example? We assess communication skills based on how they interact with the patient, but why don’t we make observations of how students communicate with other members of the team when it comes to preparing a management plan for the patient?

What would an assessment task look like if we assessed teams, rather than individuals. What if we we asked an OT, physio and SALT student to sit down and discuss the management of a patient? Imagine how much insight this would give us in terms of students’ 1) interdisciplinary knowledge, 2) teamwork, 3) communication skills, 4) complex clinical reasoning, and 5) patient-centred practice? What else could we learn in such an assessment? I propose that we would learn a lot more about power relations between the students in different disciplines. We might even get some idea of students’ levels of empathy for peers and colleagues, and not just patients.

What are the challenges to such an assessment task? There would be logistical issues around when the students would be available together, setting concurrent clinical practice exams, getting 2-3 examiners together (if the students are going to be working together, so should the examiners). What else? Maybe the examiners would realise that we have different expectations of what constitutes “good” student performance. Maybe we would realise that our curricula are not aligned i.e. that we think about communication differently? Maybe even – horror – that we’re teaching the “wrong” stuff. How would we respond to these challenges?

What would the benefits be to our curricula? How much would we learn about how we teach? We say that our students graduate with skills in communication, teamwork, conflict resolution, etc? But how do we know? With the increasing trend of institutions talking about interprofessional education, I would love to hear what they have to say about interprofessional assessment in the hospital with real patients (And no, having students from the different disciplines do a slideshow presentation on their research project doesn’t count). Or, assessment of the students working together with community members in rural areas, where we actually watch them sit down with real people and observe their interactions.

If you have any thoughts on how to go about doing something like this, please get in touch. I’d love to talk about some kind of collaborative research project.

Seminar on Inter-professional Education (IPE)

A few days ago I attended a lunchtime seminar on the value and impact of Interprofessional in health sciences education, presented by Professor Hugh Barr. I unfortunately couldn’t stay for the duration of the discussion, but I took a few notes while I was there.

“Interprofessional education (IPE) is sophisticated”. I like this because it seems that we sometimes take the stance that IPE is about putting students from different disciplines in the same room and telling them to learn about each other. It became clear during the discussion just how complex IPE is.

What opportunities exist for curriculum development in the context of IPE? What are the conversations that are happening in the classrooms around interprofessional collaboration? How can those experiences be leveraged by students and educators?

View from Sir Lowries Pass on the way to supervise students on clinical placement in Grabouw.

We place groups of 3rd year students in a rural community about an hour outside of Cape Town, and part of that clinical rotation is to try and collaborate with students from other domains. The effort is overseen (in theory) by the Interdisciplinary Teaching and Learning Unit, although in practice there are many challenges. The biggest problem, at least as reported by students, is a lack of shared objectives between the groups. Even though they have time allocated during the week in which to work together on shared projects, the individual programmes from the various departments have little in the way of real overlap. This often leads to frustration and a high attrition rate of departments dropping out of the collaborative part of the exercise.

In terms of showcasing examples of collaborative work, which ones aren’t too expensive or challenging, which have good outcomes and can serve to promote the approach i.e. what is the low-hanging fruit?

“small is beautiful”

One of the benefits of IPE is the idea that complex social and health problems in communities are beyond the capacity of any one profession to solve.

Formal publication in peer-reviewed journals isn’t the only set of outcomes to aim for. Interesting and relevant information that isn’t grounded in evidence and theory should also be shared. I liked the emphasis that Professor Barr placed on informal dissemination of information by alternative means.

On the question of how to break the dominance of medics in driving health strategy, Professor Barr suggested developing collaborative approaches while trying to integrate the medics, not alienating them and, if that failed, to move forward without them. We have at least one situation though, where medical students are driving the process the IPE in a rural community that our students are placed in. There are plenty of examples where the medics are not only willing to participate but are actually leading the way.

“Research what you teach. Teach what you research” – Professor Renfrew Christie, Dean of Research

We need to acknowledge and understand that IPE in undergraduate education is only a first step towards real collaborative practice in health systems. It’s too much to expect that after a month or two of spending time together, our students will simply know how to develop shared objectives and interventions with other professions.