Interprofessionalism: It is no surprise that adverse events in patient care are attributed in part to ineffective communication, especially at transitions of care between the inpatient and outpatient settings. One manner in which to improve this process is to promote the communication via education on intraprofessional collaboration. This study in the Journal of Medical Education shows that medical educators who are interested in building and maintaining intraprofessional collaboration may still benefit from a quick dip into this ethnographic non-participatory observational study from the Netherlands.
Forty-two residents and their supervisors at five hospitals were interviewed about collaboration between primary care physicians and medical specialists. The results (based 45 hours of taped recordings) suggest that intraprofessional collaboration between these two cohorts is promoted when there is a culture of collaboration, and power dynamics and hierarchy are limited. Three themes were identified as a means to improve the culture of collaboration: 1)while intraprofessional collaboration is implicitly learned, active learning promotes a culture change, 2)Empowering the primary care team members to promote their knowledge and skills mitigates any competing roles between the primary care (PC) team, and medical subspecialty (SC) teams and 3) shared physical space in the clinical work environment allows for equity and collaboration. Furthermore, barriers to collaboration arise when placement goals overlook collaboration and participants are not accustomed to reaching out to each other for assistance.
There are, however, some noteworthy limitations in this study. The data source was limited to emergency and geriatric departments, but the multi-site approach suggests the findings may be widespread and may be true in other departments as well. Additionally, while the observations were done in an incognito manner, they occurred in locations without active patient care. This precludes the observation of informal learning that occurs in this space.
One final note: researchers in this study used rapid ethnography — a technique of entering into the arena of study with focused questions and finding results quickly. We can only wonder then what else researchers might have found if they used the traditional ethnographic approach and took more time. While these limitations exist, this study does highlight the role training, supervision, and the clinical learning environment in the promotion of successful intraprofessional collaboration to mitigate adverse events between primary care and medical subspecialty care teams. — Payal Parikh, MD (with Editorial Team)
Natasja Looman, Cornelia Fluit, Marielle van Wijngaarden, Esther de Groot, Patrick Dielissen, Dieneke van Asselt, Jacqueline de Graaf, Nynke Scherpbier-de Haan, Chances for learning intraprofessional collaboration between residents in hospitals, Med Educ 2020 Jun 21.