Transcript Practice-based interprofessional peer

Practice-based interprofessional peer-learning between
medical and midwifery students – a pilot study
Celia Woolf¹ & Adele Hamilton²
¹Institute of Health Sciences Education, Queen Mary University of London
²School of Community & Health Sciences, City University London
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Introduction
We piloted interprofessional peer-learning for fourth year medical and
final year midwifery students on practice placement in the maternity
unit of a busy London teaching hospital.
Aims
• Enhance understanding of professional roles
• Challenge negative stereotypes
• Create opportunities for interprofessional team working in practice
Rationale
• Good communication and collaboration between doctors and
midwives improves women’s experience of labour and birth
• Poor interprofessional teamwork contributes to serious failures in
care of mothers and babies(e.g. Lewis, 2005)
• Interprofessional education aims to improve collaboration and the
quality of care (Barr, 2005)
• Peer learning benefits students as teachers and learners.
References:
Barr, H (2005) Interprofessional education: today, yesterday and tomorrow: a review. London, UK : Higher Education Academy,
Health Sciences and Practice Network.
Lewis G (Editor) (2005) The Confidential Enquiry into Maternal and Child Health (CEMACH). Why Mothers Die 2000-2002. London: RCOG Press
Study design
C. Student Focus Groups
Results
A. Role Perception Questionnaire (McKay, 2004)
The qualitative data from group feedback was analysed using
the Framework approach (Ritchie and Spencer, 1994).
Pre-training : students held preconceptions about both professions, including
some negative stereotypes
1. Involvement
Medical students considered doctors
compared to midwives as
Midwifery students considered
doctors compared to midwives as
more collaborative
equally collaborative
more effective in teams
equally effective in teams
having equally good interpersonal
skills
having poorer interpersonal
skills
more objective and more medically
focused
more objective and more medically
focused
equally holistic
less holistic
having a more transparent role
having a more transparent role
having a higher opinion of their own
profession
having a higher opinion of their own
profession
requiring a higher level of intellectual
skills
requiring a similar level of intellectual
skills
having a less caring and more
technical role
having a less caring and more
technical role
tending to work in teams more
tending to work in teams equally
more able to refer patients to other
disciplines
equally able to refer patients to other
disciplines
Post-training some of these preconceptions changed and some differences
emerged between students in the peer learning and control groups.
For instance:
Participants
Student volunteers gave informed consent to take part.
• Peer learning group n = 38
• Control group n = 26
Peer learning programme
• Practice-based reciprocal peer teaching between medical and
midwifery students
• Students explored medical and midwifery roles in antenatal
care, normal labour and complicated labour through
• joint clinical observations
• working together to care for women on labour ward
• interviewing woman about experience of maternity care
and consequences of teamwork
• researching information together
• Peer-learning handbook gave guidance
• Students gave case presentations focusing on
interprofessional teamwork in maternity care.
• medical students in both groups showed increased awareness of medical
aspects of the midwifery role.
• midwifery students in the peer learning group felt that the professional
role of doctors became more transparent , while those in the control
group rated it as less transparent.
• medical students in the peer learning group perceived both professions
as working more autonomously than before training.
• medical students in the control group strengthened their view that
midwives work less effectively in teams than doctors. This negative
stereotype did not increased among the peer learning students.
B. Student Feedback Questionnaires
Students in the peer learning group learnt about each other’s
roles and perspectives:
“We have common ground”
“Was good to get midwives view of doctors, sticking people
on IV drugs”.
“Because we all have a better understanding of each
other’s roles and have more respect for each other, will
work better together in multidisciplinary team”
3. Learning
Students in the peer learning group felt that the
interprofessional exchange of knowledge enhanced their
learning:
“Was useful to see that midwives and medical students
asked different questions and have different perspectives”.
“I am learning from midwifery students, for example how to
assess the placenta. Midwives can also learn from
medics… was good”
“By teaching it to someone else it affirms it in your own
mind”
4. Interprofessional experience
Students in the peer learning group valued the
interprofessional contact
“Much better than other IPE experiences”
“joint teaching sessions really good, much better than any
teaching we have had”
Students in the control group would have liked more
opportunities to learn interprofessionally:
“It would be useful to have student doctors and student
midwives meeting together”
100
80
60
%
normal labour
pregnancy induced hypertension
diabetes in pregnancy
complicated labour and assisted birth
2. Role Clarification
Medical and midwifery students valued the peer learning
experience equally:
• Students also attended joint weekly facilitated seminars on:
•
•
•
•
Medical students in the peer learning group found that working
with midwifery students helped them get more involved in
practice:
“Made me more part of the team”
“Able to get into labour ward more easily”
This contrasted with the experience of some students in the
control group:
“I always feel in the way as a medical student – I don’t
like to push – I don’t like to be underfoot”.
“In most …. ways I cause more trouble than help – makes
me feel like I am wasting my time … Everyone’s so busy. I
feel like I’m imposing”
40
20
• 4 weeks duration x 3 student cohorts
0
Negative
Neutral
Midwifery
Positive
Medicine
Students deepened their understanding of the role of other health
professionals:
14
12
10
8
Conclusions
6
4
2
0
Disagreed
Neutral
Agreed
Peer learning between medical and midwifery students had additional
benefits beyond those gained through opportunistic interprofessional
contact in practice. Peer learning:
Peer learning Group
Evaluation
Role Perception Questionnaire pre and post
• Student feedback questionnaires
• Student focus groups
•
Control data from students on the same maternity unit allowed
between-group comparisons to explore whether the peer
learning experience enhanced learning compared with
opportunistic interprofessional contact.
Students believed that they learned to collaborate more effectively
with other team members:
15
10
5
0
Disagreed
Neutral
Agreed
• was valued and enjoyed by students
• helped clarify professional roles
• developed understanding of how doctors and midwives collaborate
in practice
• helped medical students get greater experience of involvement
with women during labour and childbirth
• broke down barriers between the professions.
The peer learning model has potential for extending to other practice
areas.
Peer Learning Group
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www.city.ac.uk
www.qmul.ac.uk