INTERPROFESSIONAL PRACTICE EDUCATION WITHIN … · Building capacity - IP practice ... Next steps...

INTERPROFESSIONAL PRACTICE EDUCATION WITHIN ALBERTA HEALTH

SERVICES

Prepared by

Health Systems and Workforce Research Unit Health Professions Strategy and Practice

Alberta Health Services

DECEMBER 2011

Building capacity - IP practice education within AHS December 2011

Acknowledgements

Understanding practice education within Alberta and developing a proposed plan for moving interprofessional (IP) practice education forward within Alberta Health Services (AHS) was achieved with the help of our colleagues and partners within and outside AHS. Members of the project Steering Committee, Advisory Committee, Concept Design Working Group, and Learning Modules Working Group, as well as the participants at a workshop to discuss IP practice education and members of numerous working groups who identified the current state of practice education within Alberta and proposed strategies for future possibilities of IP practice education represented the following organizations:

Education partners - Athabasca University, Bow Valley College, Grande Prairie Regional College, Grant MacEwan University, Lethbridge College, Medicine Hat College, Mount Royal University, Norquest College, Red Deer College, University of Alberta, University of British Columbia, University of Calgary, University of Lethbridge, University of Manitoba, University of Saskatchewan

Government partners - Alberta Advanced Education, Alberta Health and Wellness

Health organization partners - Alberta Health Services, British Columbia Children's and British Columbia Women's Hospitals, British Columbia Provincial Health Services Authority, Saskatoon Health Region, Winnipeg Regional Health Authority

IP practice education is considered an effective way to create a collaborative practice-ready workforce which will contribute to AHS’ vision of becoming the best performing publicly funded health system in Canada and the organization’s mission to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans. The possibility of moving IP practice education forward requires the commitment, vision and support of leadership within AHS and its partner organizations.

Funding

Thank you to Alberta Health and Wellness, Health Workforce Action Plan for funding this important work.

This report fulfills one of the deliverables of the AHW HWAP funded project “Building capacity for clinical placements through interprofessional preceptor development and support”

Disclaimer

The results presented in this report do not necessarily reflect the opinions or policies of Alberta Health and Wellness.

Building capacity - IP practice education within AHS December 2011

Table of contents

Executive summary ....................................................................................................................................1

Introduction ...............................................................................................................................................5

Current issues with practice education ........................................................................................................5

Project description and deliverables ...........................................................................................................6

A. Developing the concept design and eLearning modules .......................................................... 7

Environmental scan of existing programs related to practice education ....................................................... 7 Stakeholder engagement workshop ............................................................................................................... 8 Review of the literature .................................................................................................................................. 8

B. Concept design ...................................................................................................................... 9

Guiding principles for interprofessional practice education concept design .................................................. 9 Concept map ................................................................................................................................................. 11 Summary of concept design key components .............................................................................................. 12

1. Partner engagement and communication ........................................................................12 2. Preceptor support and education .....................................................................................12 3. Practice and faculty connections ......................................................................................13 4. Interprofessional practice education framework .............................................................13 5. Organizational learning strategy .......................................................................................15 6. Organizational policies and practice standards ................................................................15 7. Use of HSPnet AB to coordinate interprofessional practice education ............................16 8. Performance monitoring ...................................................................................................16

Key strategies and Action plan ...................................................................................................................... 18

C. Interprofessional preceptor education eLearning modules ................................................... 20

Process of eLearning module development .................................................................................................. 20 eLearning module content ............................................................................................................................ 21 Curriculum design and eLearning module structure ..................................................................................... 21 eLearning module access .............................................................................................................................. 21 Piloting and evaluating eLearning modules .................................................................................................. 21

Conclusion ............................................................................................................................................... 22

Next steps ................................................................................................................................................ 22

References ............................................................................................................................................... 23

Appendix A – Glossary.......................................................................................................................................... A1

Appendix B – Stakeholder workshop report (November 30, 2010)..................................................................... B1

Appendix C – Current issues in IP practice education (Background paper) .............................................................. C1

Building capacity - IP practice education within AHS December 2011 1

Executive summary

Interprofessional practice education

The recent formation of Alberta Health Services (AHS) has created the need to review how practice education is being delivered. The former health authorities each had different ways to organize and deliver practice education and to prepare preceptors for their roles. Students who come to AHS for practice education are the single greatest future resource to provide healthcare services for the people of Alberta. Practice education is the umbrella term referring to all aspects of student clinical placements, within both the educational institution and practice setting. Research shows that students who have a positive practice education experience are more likely to return to an organization as employees. Practice education provides experiential learning opportunities for health care students during their program of learning. Students move from the educational environment to the practice environment where they practice the skills required to meet the learning objectives outlined in their program of study and the competencies of their profession. Traditionally, students are supervised by preceptors from the same health care discipline.

The growing collaborative practice approach to patient care must be role modeled for students by embedding interprofessional experiences in practice education by creating opportunities for students to learn from other professions and develop collaborative practice skills during their clinical placements. While discipline specific skills development remains the focus of practice education, the collaborative practice model of health care delivery highlights the need to formally recognise, include and address the need for an interprofessional component of practice education.

For the purposes of this document, interprofessional (IP) practice education will refer to a preferred future of practice education with an interprofessional element and focus. This requires a shift from practice education as it currently exists. Therefore, this document outlines strategies which may in the short term be considered for improving the current delivery of practice education and the future implementation of IP practice education.

The audience for this report are the decision makers within AHS who must champion IP practice education and work collaboratively with post secondary educational partners, the regulatory bodies, employment associations and provincial government departments to create a future-ready workforce. It is not the intent of this report to provide guidelines for the frontline workers to implement collaborative practice or IP practice education, rather, to provide evidence and strategies to those tasked with the implementation of IP practice education within AHS.

Project deliverables

Alberta Health and Wellness, Health Workforce Action Plan provided funding to AHS, Health Professions Strategy and Practice to build capacity for clinical placements through interprofessional preceptor development and support. Project deliverables were online interprofessional learning modules for preceptors of students from all healthcare disciplines and a concept design identifying core components and proposed strategies for supporting preceptors, students, and AHS staff involved in IP practice education.


A. eLearning modules

The online learning modules (eLearning modules) were developed to provide frontline staff with the skills and knowledge needed to be preceptors for healthcare students.

Based on an environmental scan, a literature review, findings from a workshop, and working group member expertise, module content focused on the following themes: preceptor competencies, setting the stage, competencies of patient-centred collaborative care, teaching strategies, learning styles, managing difficult/challenging situations, feedback and evaluation, models of supervision, and conflict.

The modules will be available to staff of AHS, its affiliates, and partners.

B. Concept design

A concept design, developed in partnership with internal and external stakeholders, identifies core components and proposed strategies for supporting preceptors, students, and AHS staff involved in IP practice education. The concept design will expand and standardize AHS’ understanding of practice education issues and opportunities and support more systematic and strategic implementation of IP practice education. This will contribute to AHS’ vision of becoming the best performing publicly funded health system in Canada and the organization’s mission to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.

Key components of the concept design Based on information retrieved from the literature, stakeholder discussions and from a provincial workshop, the following components were identified as being essential for practice education: partner engagement and communication, preceptor support and education, practice and faculty connections, interprofessional practice education framework, organizational learning strategy, organizational policies and practice standards, use of HSPnet AB to coordinate interprofessional practice education in Alberta, and performance monitoring. These strategies can provide guidance for innovating practice education within AHS.

1. Partner engagement and communication

Development of an AHS IP practice education strategy requires engagement of a broad range of partners within AHS (e.g. senior leadership, managers, preceptors) and from external organizations (e.g. educators, regulatory bodies, professional associations, government, Primary Care Networks). Clearly defined vision, outcomes, and roles are required to facilitate commitment and partnership effectiveness. A comprehensive communication strategy, with key messages tailored to specific groups while retaining consistency across messages, is essential. Partner engagement and communication require dedicated resources including staff to further develop and implement strategies outlined. Leadership for partner engagement and communication is crucial.

2. Preceptor support and education

Well-trained and dedicated preceptors are critical to the success of IP practice education programs and students’ placement experience. Having appropriate structures and processes in place to support and


educate preceptors facilitates recruitment and retention of preceptors. Creating an organizational culture that embraces IP practice education as an opportunity facilitates the work of preceptors.

3. Practice and faculty connections

Strong partnerships between the healthcare organization and educational institutions need to be in place to ensure a shared vision and strong commitment from the highest levels of the partner organizations around IP practice education. This requires inter-sectoral champions to address IP practice education issues. The Collaborative Practice and Education Steering Committee may facilitate some of these partnerships at the executive level; the executive level must then provide leadership and support to achieve the linkages through their respective organizations. Strategies developed for practice and faculty connections will need to link closely to partner engagement and communication strategies.

4. Interprofessional practice education framework

An IP practice education framework will facilitate a consistent, efficient approach to a student placement process that supports the development of a collaborative practice-ready workforce. Currently, AHS does not have a finalized practice education framework; however, the draft practice education framework document acknowledges practice education is a priority for AHS and details the principles necessary to support practice education: student-focused, evidence-based, strategically focused, responsive, sustainable, inclusive, transparent, and equitable. Underlying assumptions are identified, and outputs and outcomes are stipulated along with the partners with whom AHS must collaborate to achieve IP practice education.

Within a number of Health Canada funded research projects, an IP mentoring approach has been developed. IP mentoring is consistent with professional body requirements around practice supervision, helps students develop collaborative practice competencies and can be implemented within existing practice education processes. The basic structure of the clinical placement is not altered but facilitators highlight and leverage the IP competencies inherent in any health professional training. This approach relies on full participation of staff from different professions to act as mentors for healthcare students. Faculty and practice champions must be educated and supported to ensure the success of this approach.

5. Organizational learning strategy

Education and learning is a stated goal of AHS and will be achieved by providing opportunities for training and education, access to tools, and incentives to achieve excellence in providing health services. Preliminary steps to developing an organizational learning strategy to support IP practice education is to understand the continuing education needs of AHS staff around collaborative practice competencies and IP mentoring. A comprehensive organizational learning strategy addressing perceived competency gaps is required to produce a workforce that is ready for the future with the qualifications, skills, attributes and experience required to continue providing excellence today and tomorrow.

6. Organizational policies and practice standards

AHS currently does not have policies and standards regulating IP practice education and student placements. A draft Student Placement Policy has been developed and is awaiting final endorsement. It acknowledges AHS as a teaching and learning organization that supports and encourages the participation of students in clinical, corporate, technical or administrative placements. It also states the


intent of AHS to “endeavour to support interprofessional education experiences” within the context of collaborative patient-centred practice. In the future, a policy which explicitly states an expectation of IP practice education would strengthen it and support a consistent approach across AHS.

7. Use of HSPnet AB to coordinate interprofessional practice education

HSPnet is an electronic system for improving the management of practice education activities for health sciences students. Student placements in AHS are tracked in HSPnet AB. However, HSPnet AB is not used consistently by educational institutes throughout the province. Some aspects of HSPnet AB challenge the provincial integration of student placements. Given the focus on IP practice education by the provinces currently using HSPnet to coordinate student placements, support for changes to the database which facilitate IP placements should be proposed by Alberta Health and Wellness and the lead agencies of the other provinces that comprise the National HSPnet Steering Committee.

8. Performance monitoring

Ongoing evaluation of the effectiveness of IP practice education programs assists healthcare facilities, educational institutes and other stakeholders to determine what is working well and what should be changed or eliminated in the program. This requires clear expectations around anticipated outcomes, and a data infrastructure and metrics to measure IP practice education performance and outcomes. To achieve this, leadership, strategic planning, facilities and equipment, and policies all need to support IP practice education and require ongoing monitoring to ensure desired performance. The British Columbia Academic Health Council has developed two self assessment checklists to “support a comprehensive assessment of practice education infrastructure, as well as practice education quality review, planning, and improvement” (2008a 2008b). Completing these checklists is an excellent starting point for identifying areas of strength and areas in need of improvement. Development of a more detailed performance matrix that aligns, if possible, with AHS Tier 1 measures needs to follow.

Next steps

The development of the IP practice education concept design has created a lot of interest and awareness across the province. The time is right to move forward and innovate practice education. The eLearning modules and the concept map create an important first step; the strategies and actions outlined in the document assist in the short term to improve the current delivery method of practice education within AHS and to implement IP practice education over the mid and long term. A number of immediate actions are recommended:

Implement and evaluate eLearning modules

Validate the concept design components and proposed action plan with appropriate AHS executives and external stakeholders

Secure executive sponsorship to champion this IP practice education action plan within AHS and its partners

Develop a working group to implement this IP practice education action plan


Introduction

In its framework for action, the World Health Organization (2010) has made an urgent call to policy makers, decision makers, educators and health workers to embed interprofessional education and collaborative practice in all the services they deliver. They state that, “Internationally, interprofessional education and collaborative practice are now considered credible strategies that can help mitigate the global health workforce crisis” (p.22). However, there is ample evidence that the current health workforce is not collaborative practice-ready, that is, healthcare providers, including new graduates, lack the competencies to work effectively in interprofessional teams.

The complexity of health provider education means that education can no longer be conceived as a system where educational institutions "teach" students how to do things, while health services provide the opportunity for them to "practice" things with real people. This involves recognition that the production of knowledgeable, skilled, and competent graduates is a shared responsibility. Students can expect to spend between 30-50% of their education in clinical placement settings where health services are delivered and students learn how to apply their knowledge in a “real life” context. Practice education is designed to bridge classroom theory and professional practice and is used as an umbrella term to describe all aspects of student placements, within both the educational institute and practice setting. During the preceptored practice education experience, students are paired with a preceptor, that is, a healthcare provider from the same discipline that helps the student learn the roles in a particular area of practice. The preceptor supervises and evaluates the student. The preceptorship must be viewed as an essential component of high quality health provider education for which universities and health services provide the necessary resources. Within this context, interprofessional (IP) practice education refers to clinical placements where students have opportunities to learn from professionals from other disciplines to develop collaborative practice skills. IP practice education is considered an effective way to create a collaborative practice-ready workforce.

Current issues with practice education

The recent formation of Alberta Health Services (AHS) created the need to review how practice education is being delivered. The former health authorities each had different ways to organize and deliver practice education and to prepare preceptors for their roles. AHS is now responsible for the majority of practice education placements across the province and there is a need for a standardized approach to practice education and preceptor development.

For 2009, Health Professions Strategy and Practice (HPSP) tracked, through HSPnet AB, approximately 15,000 placements for 5000 students. These represent primarily nursing students. Most other professional groups do their own tracking or do not use HSPnet AB. There are a number of other healthcare disciplines engaged in practice education experiences with preceptors which are not under the AHS umbrella. A conservative estimate for total number of preceptors needed in AHS annually would be 6000, highlighting the scale of the practice education needs.


There are a number of issues with current practice education.

Current human resources shortages have reiterated the need to focus on practice education as a critical transition for future graduates into the healthcare workforce.

There is increasing demand for practice education with overall increasing enrolment in health sciences disciplines.

There are not enough preceptors identified and willing to supervise students; not all preceptors are prepared to teach and mentor, and may lack the support needed to be a high quality preceptor.

Some practice settings across the continuum of care are not being fully used for practice education (e.g. contracted agencies such as long term care centres).

Practice education has not kept up with changes in healthcare delivery, in particular the focus on care delivered by interprofessional teams.

Technology is not fully leveraged to plan, implement and deliver practice education (e.g. HSPnet AB used inconsistently across AHS).

Practice education is discipline specific with little attention paid to opportunities to learn with, from and about each other and to collaborate.

There is a lack of coordination in decision making across education and practice sectors.

Students who come to AHS for practice education are the single greatest future resource to provide healthcare for the people of Alberta. Students who have a positive practice education experience are more likely to return to an organization as employees in the future. Innovative approaches to high quality practice education are needed that create capacity for placing students across health professions, develop new graduates that are collaborative practice-ready and interested in joining the AHS workforce, and preceptors that can role model best practice behaviours and help transition new graduates into the workplace.

Project description and deliverables

It is the mandate of AHS, HPSP to chart the course of practice education provincially within AHS. HPSP received funding from Alberta Health and Wellness (AHW), Health Workforce Action Plan (HWAP) to develop a preceptor training, development and support program that is sustainable, accessible, and improves the quality of the IP practice education experience. Interprofessional practice education refers to situations where two or more health professions jointly create and foster a collaborative learning environment. The goal of these efforts is to develop knowledge, skills and attitudes that result in interprofessional collaborative behaviours and competence. Furthermore, the program is to be evidence-based and grounded in best practice.

Two AHS inter-departmental working groups were created to undertake the HWAP project deliverables. The Learning Modules Working Group was charged with the development, implementation and evaluation of online learning modules for preceptors that address IP skills. These modules are being developed so they are appropriate for use by a variety of disciplines. It is hoped they will also move the education of preceptors


towards a model of collaborative practice within an interprofessional team that understands and respects the roles of each individual who is working towards the delivery of high quality patient care. Membership of the working group consisted of frontline healthcare providers, clinical educators and researchers. The deliverable of the Concept Design Working Group was a draft concept design that outlines strategic concepts to support infrastructure and processes for IP practice education within AHS including aspects of planning, culture, quality and operations. While the development of the concept design is focused on IP practice education, most if not all the strategies can also be used to improve the current delivery of practice education within AHS in the short term and work towards attaining IP practice education in the mid to long term. The Concept Design Working Group consisted of researchers, educators and practice leaders from HPSP, a representative from Human Resources (Learning Support), and a unit manager.

The working groups were guided and supported by an Advisory Committee which was comprised of members from AHS, an educational institute, and government representatives.

A. Developing the concept design and eLearning modules

The eLearning module content and concept map and design were developed using information from an environmental scan, a stakeholder workshop and consultation, and literature review.

Environmental scan of existing programs related to practice education

An initial step included an environmental scan of existing programs within the province, nationally and internationally. A targeted approach was used for the environmental scan. Programs identified during the proposal stage of this project were the starting point and included programs used by former entities of AHS, health organizations in other jurisdictions, and educational institute programs. Members of the proposal development team also provided names and/or web addresses of provincial, national or international sources or organizations known to offer preceptor or interprofessional education. Additional programs were reviewed as a result of cascading from the pre-identified sources (e.g. links to other preceptor training from the pre-identified source). This method resulted in the review of 39 programs or sources. The majority focused on a single discipline (e.g. nursing, pharmacy). Ten contained material related to IP practice education.

Common themes from the 39 programs reviewed were: i) roles and responsibilities of student, preceptor and educational institute, ii) preceptor competencies, characteristics and attributes, iii) principles of adult learning, iv) learning styles or learning cycle, v) teaching methods, strategies, techniques and styles, vi) strategies for providing IP experiences and learning opportunities, vii) modeling IP teamwork, viii) strategies for integrating students into practice, ix) assessing learning needs, x) critical thinking, clinical reasoning and self-reflection, xi) evaluation and feedback, and xii) conflict management. Based on the review of existing programs and a cursory review of concepts in the literature, a high level draft concept design and the eLearning module content themes were developed. Another specific output from the environmental scan was a summary of definitions relevant for IP practice education. The glossary is attached in Appendix A.


Stakeholder engagement workshop

The Concept Design Working Group invited stakeholders from educational institutions, government departments, healthcare organizations and AHS to a full-day workshop to review and provide critical feedback on a draft concept design and the preceptor eLearning module content themes. The event was hosted at three sites (Lethbridge, Calgary and Edmonton) with online connection to allow for broader participation (n=87). It was the first step to engage the numerous partners across Alberta involved in practice education and to start the dialogue around a future common vision.

The objectives of the workshop were to:

a) Share current and emerging approaches to IP preceptor education and support across the western provinces

Validate a draft concept design for IP practice education

b) Identify the structures, processes and people relevant for IP preceptor education and support

Identify gaps in the concept design

Reach consensus on core components for successful and sustainable IP preceptor education and support

Draft high level strategies for the development, implementation and evaluation of concepts outlined in the design

c) Review and provide feedback on the draft IP preceptor eLearning modules themes.

Workshop participants agreed with the eLearning module content themes and the need for a common vision around IP practice education and preceptor development and support. This would facilitate a move from pockets of excellence to a system-wide culture that fosters IP education and practice to benefit patients. Participants stressed the importance of organizational support from all levels. They also saw the need to ground the IP practice education program in a culture of collaboration and innovation where partners work together to increase the quality of patient care. Workshop participants identified areas of focus for advancing IP practice education in AHS: i) stakeholder engagement, ii) communication, iii) organizational culture supportive of IP practice education, iv) strategic plan, policies, organizational learning strategy and leadership development, v) infrastructure and resources, vi) quality assurance, vii) IP practice education model, and viii) support. Two topics were identified as highest priority: i) partner engagement and communication, and ii) preceptor education and support strategies. The full workshop report is available in Appendix B.

Review of the literature

As proposed by workshop participants, a more comprehensive review of the literature was conducted for the two high priority issues: partner engagement and communication strategies, and preceptor education and support strategies. All workshop attendees (n=87) were invited to collaborate on working groups; 26 participated in reviewing the literature and developing strategies for those two topics. The final review


included, in addition to the two high priority topics, the following issues: practice and faculty connections, interprofessional practice education framework, organizational learning strategy, organizational policies and practice standards, use of HSPnet AB to coordinate IP practice education, and performance monitoring. The full background report is in Appendix C. The findings from the literature review were used to inform the more detailed development of the concept design including high level strategies for operationalizing the IP practice education program.

B. Concept design

The concept design, developed in partnership with internal and external stakeholders, identifies core components and proposed strategies for supporting preceptors, students, and AHS staff involved in IP practice education. The concept design will expand and standardize AHS’ understanding of practice education issues and opportunities and support more systematic and strategic implementation of IP practice education.This will contribute to AHS’ vision of becoming the best performing publicly funded health system in Canada and the organization’s mission to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.

Guiding principles for interprofessional practice education concept design

The development of the IP practice education concept design was guided by a number of principles that needed to be reflected in each concept and strategy.

• Interprofessional: Interprofessional principles underpin the practice education concept design.

○ The concept design should be applicable to all health professions under AHS’ practice education mandate.

○ Practice education will integrate interprofessional concepts; that is, students and staff involved in IP practice education will have opportunities to learn and work with each other across disciplines.

○ The concept design is being developed and validated by an interprofessional group consisting of educators, researchers, managers, students, preceptors and corporate representatives from different departments.

• Based on a learning organization culture: “Organizations where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free, and where people are continually learning to learn together” (Senge 1990 p.3).

• Applicability across practice settings/continuum of care: Concepts developed for IP practice education need to be applicable and relevant for any healthcare context across the continuum of care.

• Valuing individual contributions: In IP practice education each individual’s contribution, but in particular those of preceptors and staff, will be valued and recognized.


• Context relevancy, policy integration, multilevel system change and collaborative leadership: In their call for action, the World Health Organization (2010) working group has highlighted the importance of practice initiatives being context relevant, integrated into policy, considering change at multiple levels, and supported by collaborative leadership.

• Linked to AHS mission, goals and values: The concept design needs to fully align with AHS strategic plan’s goals of access, quality, and sustainability as well as the AHS values of safety, learning, performance, respect, accountability, transparency, and engagement.

• Evidence-informed, based on best practices: The concept design will be driven by best evidence and will draw on expertise and successful IP practice education innovations within AHS and in other jurisdictions, in particular the western provinces.

• Align with other relevant initiatives across Alberta: The concept design will align with, build on and leverage other programs and initiatives across Alberta that are relevant to practice education such as:

○ AHS Transformational Improvement Program 4: Enabling our people to achieve excellence in providing health services. Key actions under this workforce transformation project are a staff learning and development strategy, employee recognition programs, leadership development, interprofessional teams to support full scope of practice, collaborative labour relations, workplace health and safety, and enhancement of the patient experience.

○ Collaborative Practice and Education Framework for Change: Stakeholders from the Alberta government, post secondary educational institutions, regulatory colleges, and healthcare employers have formed a multi stakeholder committee (Collaborative Practice and Education Steering Committee) to develop a framework for collaborative practice and education in Alberta. The framework aims to advance collaborative practice as a way of providing healthcare services and collaborative education; serve as a foundation for healthcare providers, regulators, educators and government to make changes to the current health system and practices; and set the direction for current and future initiatives at all levels. One focus area is educating current and future workers, management, faculty and preceptors.


Concept map

The concept map graphically illustrates the core components required for the delivery of high quality practice education in the short term and to promote the future development and implementation of IP practice education within AHS. It focuses on structures and processes across multiple levels and stakeholder groups. There is an inherent interdependency among and between concepts. The concept design will guide the development of IP practice education strategies which help identify and support opportunities for IP practice education wherever they exist.


Summary of concept design key components

This section summarizes the key concepts found in the literature. These were identified as significant components for decision and policy makers to support and facilitate IP practice education. Many of these components, within the context of AHS, can be used to enhance existing practice education structures and processes. For more detailed information about IP practice education, review the comprehensive background report (Appendix C).

1. Partner engagement and communication

The development of an AHS IP practice education strategy requires the engagement of a broad range of partners within AHS (e.g. senior leadership, managers, preceptors) and from external organizations (e.g. educators, regulatory bodies, professional associations, government, primary healthcare clinics). Clearly defined vision, outcomes, and roles are required to facilitate commitment and partnership effectiveness. Engaging partners and other stakeholder groups will require the development of a comprehensive communication strategy. Key messages, tailored to specific groups while retaining consistency across messages, are essential. Examples of important messages include: the positive impact of collaborative practice on patient outcomes; the attractiveness of IP practice education for students; preceptoring as a staff strategy for ongoing learning and career development; the opportunities for recruitment and retention; and how the standardization of IP practice education across disciplines and across the province will improve patient and provider outcomes. Partner engagement and communication require dedicated resources including staff to further develop and implement strategies outlined. Leadership for partner engagement and communication is crucial.

2. Preceptor support and education

Well-trained and dedicated preceptors are critical to positive student placement experiences, the success of the current practice education requirements, and future IP practice education programs. Preceptors’ commitment to their role is directly related to the degree of support they receive and rewards and recognition that are in place. Having appropriate structures and processes facilitates recruitment and retention of preceptors. There are a number of strategies to provide that support: i) education, ii) workforce adjustment and support from colleagues and supervisors, iii) structures and processes to formalize goals and expectations for the practice education program, the preceptor and the student, iv) networking opportunities for preceptors, and v) rewards and recognition of preceptors and their role. Creating an organizational culture that embraces IP practice education as an opportunity facilitates the work of preceptors.

Educating preceptors is one of the most important support strategies available to an organization. When preceptors are well-prepared for their role, they report being more confident in their skills, experience greater job satisfaction, and increased satisfaction precepting. Students mentored by well-prepared preceptors report a more satisfactory student placement experience. They comment that preceptors were more accessible, seemed more interested in them both professionally and personally, acted as professional role models, and improved students’ learning.


There are different methods to deliver education: electronic or web assist format which can be interactive or static; face-to-face education through workshops, seminars and lunch and learns; print sources such as manuals and resource binders; or blended formats. There are advantages and disadvantages to each method but adult education literature indicates blended formats that include experiential experiences are most effective.

A set of eLearning modules are currently under development to provide consistent, efficient, convenient learning opportunities for preceptors and other staff throughout AHS.

3. Practice and faculty connections

A critical piece in examining the role of preceptors in the organization is the relationship between preceptors and educational institutions. Current practice education is not always conducive to students learning their role as health professionals or preparing them for collaborative practice. There is often poor alignment between the stated objectives of the educational institutions and approaches of the people responsible for educating students in clinical settings. The literature consistently reports that strong partnerships between the healthcare and educational organizations need to be in place including a strong commitment from the highest levels of the partner organizations. Strategies developed for practice and faculty connections will need to link closely to partner engagement and communication strategies.

Many provinces have multi stakeholder committees in place (e.g. British Columbia Academic Health Council, Saskatchewan Academic Health Sciences Network) that join education, practice and government partners with responsibility for clinical services, health research and education of future healthcare professionals. The goal of such a council or network is to facilitate collaboration, communication and knowledge brokering between the health and education sectors, and to support initiatives at a provincial level. Alberta has recently developed the Collaborative Practice and Education Steering Committee (CPESC) which is a multi stakeholder committee including Alberta government representatives, post secondary educational institutions, regulatory colleges, and healthcare employers. This collaborative partnership has been formed to develop a framework for collaborative practice and education in Alberta. The framework aims to advance collaborative practice as a way of providing healthcare services and collaborative education; serve as a foundation for healthcare providers, regulators, educators and government to make changes to the current health system and practices; and set the direction for current and future initiatives at all levels. One focus area is educating current and future workers, management, faculty and preceptors. There is potential for CPESC to take on an equivalent role to the British Columbia and Saskatchewan partnerships.

4. Interprofessional practice education framework

There are a number of healthcare trends (e.g. increasing enrolment of health sciences students which means increasing demand for practice education, shortage of health professionals, overwhelming workloads, increased patient acuity, and decreased willingness of staff to take on preceptor roles) that necessitate a review of how IP practice education is being delivered. There is also a push towards


collaborative practice models and the need to develop collaborative competency in new graduates. This all requires an innovative approach to IP practice education that creates IP practice education capacity, lessens the burden for preceptors, and enhances students’ readiness to work in interprofessional teams.

Currently, AHS does not have a finalized practice education framework; however, the draft practice education framework document acknowledges practice education as a priority for AHS and details the principles necessary to support practice education: student-focused, evidence-based, strategically focused, responsive, sustainable, inclusive, transparent, and equitable. Underlying assumptions are identified, and outputs and outcomes are stipulated along with the partners with whom AHS must collaborate to achieve IP practice education.

A number of models have been explored in the past (e.g. IP team placements, peer mentoring) to promote students’ collaborative practice competencies. Some of them have logistical challenges for implementation. Within a number of Health Canada funded research projects, an IP mentoring approach within an IP practice education framework has been developed. IP mentoring is consistent with professional colleges and regulatory bodies requirements around practice supervision, helps students develop collaborative practice competencies and can be implemented within existing practice education processes. AHS Health Systems and Workforce Research Unit is developing an IP mentoring guide which will be available soon.

Interprofessional mentoring is an educational strategy that promotes student mentoring in clinical placements by members from different health disciplines including staff and students. Marshall and Gordon (2005) explain that the purpose of IP mentorship is not to inculcate students into different professions, rather it should be “about professions learning from and about each other to improve collaboration and quality of care” (p.40). These mentoring experiences supplement formal preceptorship/clinical supervision. For example, a nursing student in a clinical practicum is supervised and evaluated by her nurse preceptor. In addition, this student has mentoring relationships with other healthcare providers (e.g. occupational therapists, social workers, physicians) and other students in her placement. IP mentors are not intended to replace the assigned preceptor; rather they supplement, support and enhance the supervisory role of the student’s principal preceptor. For example, students may shadow an IP mentor, develop a patient care plan in collaboration with an IP mentor or student, or accompany a complex client on visits to other providers. These opportunities promote collaboration and shared learning among staff and students. Responsibilities for mentoring are shared by the group, thereby reducing the burden for the individual preceptor.

The IP mentoring approach takes advantage of pre-existing practice education without adding new courses, yet offers increased opportunities for IP learning. It incorporates adult learning principles to integrate practice experiences, knowledge acquisition and reflection by offering multiple strategies to learners. This approach relies on individual faculty and staff support and has been found to have a greater reach than optional IP courses, to be less challenging to implement and less costly than full


program changes. Faculty and practice champions must be educated and supported to ensure the success of this approach.

5. Organizational learning strategy

Education and learning is a stated goal of AHS and will be achieved by providing opportunities for training and education, access to tools, and incentives to achieve excellence in providing health services. Preliminary steps to develop an organizational learning strategy include understanding the current state of continuing education in AHS, specifically as it relates to collaborative practice competencies and IP mentoring, and working with our practice and education partners to coordinate efforts to produce a workforce that is ready for the future with the qualifications, skills, attributes and experience required to provide excellence today and tomorrow. While an AHS organizational learning strategy is not currently available, some aspects of such a learning strategy are being implemented throughout AHS. Based on the Learning and Development Policy some examples are: MyLearningLink which provides AHS staff with a single point of access for AHS learning opportunities, a learning inventory to inform the future direction of the learning strategy, and access to the LEADS for a Caring Environment framework to assist managers identify competency gaps and learning opportunities for their employees.

6. Organizational policies and practice standards

AHS’ policies have organization-wide application and help ensure compliance, mitigate organizational risk, and provide a framework for planning, action and decision making. The purpose of a policy is to set a clear, predetermined, and predictable course of action for the organization. Policies are enacted through the application of procedures, which provide the information necessary for individuals to fulfill the intent articulated in AHS policies.

AHS currently does not have policies and standards for IP practice education. A draft Student Placement Policy has been developed and is awaiting final endorsement. The draft policy acknowledges AHS as a teaching and learning organization that supports and encourages the participation of students in clinical, corporate, technical or administrative placements. It also states the intent of AHS to “endeavour to support interprofessional education experiences” within the context of collaborative patient-centred practice. It stipulates the primary responsibility of AHS staff and instructors and outlines the requirement for Student Placement Agreement, information retention and record keeping. The draft policy also specifies student placement eligibility, student placement approvals, and student placement requirements. The draft policy contains definitions for several terms and refers to a number of reference documents. In the future, a policy which explicitly states an expectation of IP practice education would strengthen it and support a consistent approach across AHS. Until the policy is approved, former health entities (also known as legacy) policies remain in effect.

Some jurisdictions, such as the United Kingdom North West National Health Service, have policies that speak to an IP focus in practice education and expectations for staff to act as preceptors and/or mentors. The policy includes explicit statements regarding the opportunity for students to learn about


the whole patient experience by working within an IP team. The Australian Capital Territory Health policy defines IP practice and assigns accountabilities and responsibilities for the implementation of IP practice. The policy also describes ways in which the organizations’ values of collaboration, care and respect can be put into action, evidenced and evaluated.

7. Use of HSPnet AB to coordinate interprofessional practice education

The Health Sciences Placement Network (HSPnet) was developed by the British Columbia Academic Health Council (BCAHC), for use in British Columbia. HSPnet is an electronic system for improving the management of practice education activities for health sciences students. HSPnet facilitates practice education management activities and related activities such as policy management and agreement tracking, preceptor recognition, instructor assignment and scheduling, and collaborative resolution of scheduling conflicts. HSPnet streamlines manual processes for managing practice education, improves communications and information sharing, and brings together multiple local data sets to provide better system-wide information. Student placements in AHS are tracked through HSPnet AB; however, not all health disciplines are currently using HSPnet AB to arrange student placements. Within AHS, Health Professions Strategy and Practice is responsible for the administration of HSPnet AB.

HSPnet AB is not used consistently within AHS or by educational institutions throughout the province. Nursing faculties are currently the highest users of HSPnet AB. Other professions are increasing use of HSPnet AB for student placements but are sometimes challenged with its scheduling tools. Additionally, HSPnet AB is not fully “automated” since the receiving coordinator often must act as intermediary between HSPnet AB and the receiving service area. A recent survey conducted by AHS identified current challenges with HSPnet AB and potential solutions. The survey also provided a more accurate list of placement coordinators from education and of people involved in managing placements at AHS practice sites. This is an important aspect as many coordinators involved in practice education have changed their role in the recent AHS realignment process. The survey findings report will be available in the near future.

Given the focus on IP practice education by the provinces currently using HSPnet to coordinate student placements, support for changes to the database which facilitate IP placements should be proposed by AHW and the lead agencies of the other provinces that comprise the National HSPnet Steering Committee.

AHW and AHS will consider how to mitigate challenges with the current HSPnet AB functions through discussion with HSPnet AB partners in the province.

8. Performance monitoring

Ongoing evaluation of the effectiveness of practice education programs assists healthcare facilities, educational institutes and other stakeholders to determine what is working well and what should be changed or eliminated in the program. This requires clear expectations around anticipated outcomes, and a data infrastructure and metrics to measure practice education performance and outcomes.


There is limited information in the literature on what needs to be measured and how; reliable measures or assessment tools do not exist. Most commonly, programs capture practice education capacity (numbers of students that can be accommodated in various locations at various times), numbers of students actually placed, preceptors recruited and trained, or in some cases, number of students hired into permanent positions at their clinical placement site. These numbers are currently only tracked for faculties that use HSPnet AB. Furthermore, these measures capture activities, which may provide little insight into the quality of IP practice education and areas for improvement, rather than outcomes. Education faculties assess student satisfaction with their practice education experience, but rarely is the feedback relayed back to preceptors and staff. No practices are in place to monitor preceptor satisfaction with their role.

The literature states that the broader organizational environment needs to be set up for high quality practice education. This means that leadership, strategic planning, facilities and equipment, and policies all need to support practice education and require ongoing monitoring to ensure desired performance. The BCAHC has developed two self assessment checklists for building quality in practice education. The checklists are designed to “support a comprehensive assessment of practice education infrastructure, as well as practice education quality review, planning, and improvement” (2008a 2008b). Both checklists cover the areas of leadership, strategy and engagement; building capacity and tracking performance; collaboration and innovation; and delivery and support from an organizational level and unit level, respectively. Completing these checklists is an excellent starting point for identifying areas of strength and areas in need of improvement. Development of a more detailed performance matrix that aligns, if possible, with AHS Tier 1 measures needs to follow.


Key strategies and Action plan

Key strategies and action for the concept design core components are presented individually; however, there is an inherent interdependency among and between these concepts which must be heeded to ensure the required planning, implementation and delivery of high quality IP practice education within AHS. Many of the following strategies can be used in the short term to facilitate current delivery of practice education and in the mid to long term to develop and implement IP practice education.

Strategy

Time Frame

Performance outcomes

Accountability / Partners

Identify and engage partners

Identify internal AHS partners and external partners

Provide background materials on the practice education initiative

Develop formalized partnership agreement (e.g. common vision, roles, commitment)

Appoint a leader for partner engagement and management of the partnership

Encourage active participation of partners in decision making

Year 1 Engagement of a broad range of stakeholders internal and external to AHS

Formalized partnership agreement

Leader appointed Participants are involved and

satisfied with the partnership

HPSP

Develop a communication strategy

Develop tailored messages (content and format) for various internal and external stakeholder groups

Key messages should include: ○ Benefits of IP collaborative practice to

patient, provider, and system level outcomes

○ Partnership among organizations is required for a consistent approach to IP practice education

○ IP practice education is attractive to students

○ IP practice education supports recruitment and retention

○ Standardization of IP practice education across disciplines and across the province will improve patient and provider outcomes

○ All staff and physicians have a responsibility to educate and foster learning in our organization

○ Workload of mentoring students can be facilitated through IP mentoring

Year 1 Tailored but consistent messages are developed for different groups

Key messages reflect AHS goals and strategies

Appropriate communication media used based on stakeholder consultations

All stakeholder groups are well informed of the initiative and its activities

Communications, HPSP

Preceptor support and education

Implement structures and processes to facilitate the preceptor role ○ Workforce adjustment and colleague

support ○ Formalized goals and expectations ○ Networking opportunities ○ Rewards, recognition, incentives

Years 1-3

Increased job satisfaction of preceptors

Increased number of preceptors recruited and retained

HPSP, HR


Strategy

Time Frame



Training and education

Practice and faculty connections

Create a structure with AHS and all academic partners, at the institutional level rather than discipline specific, to develop IP practice education

Link student IP practice education objectives more closely to education curriculum

Formally incorporate more IP learning components into course objectives, student evaluation, and clinical assignments

Years 1-3

Cross sectoral structure with regular meetings to discuss IP practice education issues

HPSP, Educational partners, AHW, Advanced Education and Technology

Interprofessional practice education framework

Develop and implement an IP practice education framework that builds on prior Alberta initiatives ○ Inform a sustainable, coordinated,

systematic approach to IP practice education in AHS

○ Develop and implement strategies to expand AHS’ capacity for IP practice education including recruitment of new sites (e.g. in continuing care, primary care networks, etc.) and new preceptors

○ Focus on improving the quality of student IP practice education opportunities provided in AHS

Years 2-3

Increasing number of IP practice education placements

HPSP, HR, Educational partners, Regulatory bodies

Organizational learning strategy

Undertake a province-wide survey of healthcare providers continuing education needs related to collaborative practice competencies and IP mentoring

Develop and implement a continuing education curriculum for developing collaborative practice competencies

Year 1 Years 2-3

Staff surveyed about their education needs

Courses offered and attended

by staff Positive course evaluations

HR, HPSP HR, HPSP

Organizational policies and practice standards

Develop AHS policies and standards for IP practice education ○ Include explicit statements about the

expectations for students to engage in IP learning activities

○ Define IP practice education and assign accountabilities and responsibilities for the implementation of IP practice education

Ensure AHS policies and standards on IP practice education are aligned with those of partners

Year 1 Consistent AHS policies for IP practice education

HPSP

Use of HSPnet AB to coordinate interprofessional practice education

Undertake a province-wide survey on the practice placements processes and use of

Year 1

Survey completed HPSP


Strategy

Time Frame



HSPnet AB Work with National HSPnet Steering

Committee and BCAHC to adapt HSPnet so it facilitates IP student placements

Promote use of HSPnet AB throughout AHS and with education partners for coordination of IP student placements

Years 2-3

HPSP, AHW, BCAHC

Performance monitoring

Develop and implement data infrastructure and metrics to measure IP practice education performance and outcomes

Year 2 Performance measuring framework and metrics developed

HPSP, DIMR, HR

C. Interprofessional preceptor education eLearning modules

When preceptors are well-prepared for and supported in their role, they report higher confidence in their skills, greater job satisfaction, and increased satisfaction precepting. Preceptors who have ongoing support report positive perceptions of the role regardless of the number of students they precept. Preceptors who do not have continued support report decreased perception with higher numbers of preceptees. Preceptors who feel well supported report greater intent to remain in the unit, facility or organization. (See Appendix C for additional information about the importance of preceptor support and education, and the structures and processes that facilitate the preceptor role.)

Educating preceptors is one of the most important support strategies available to an organization. HPSP identified the need for consistent, efficient, convenient learning opportunities for preceptors and staff throughout AHS. The development of online learning modules provides the greatest flexibility for learners and ensures consistent content delivery for the organization. The online learning modules (eLearning modules) developed by HPSP provide frontline staff, and other staff who may be involved with precepting or mentoring students, with the skills and knowledge needed to be preceptors for healthcare students. The modules will be available to staff of AHS, its affiliates and partners.

At this time, the learning modules are not mandatory for staff responsible for precepting or mentoring students or other staff.

Process of eLearning module development

A working group, comprised of frontline healthcare providers, clinical educators and researchers, undertook the eLearning module development. The following process was used.

• Preparatory work - Scan programs (provincially, nationally and internationally) and search the literature for best practices in IP preceptoring; develop a brief summary of relevant concepts and strategies

• Content development - Identify core content areas that need to be included in the online module; develop curriculum content


• Format development - Identify platform to be used for online module delivery; use various media and technology to ensure the module is appealing and user-friendly

• Curriculum implementation - Translate curriculum content into online format

• Preceptor training - Recruit a pilot cohort of preceptors to complete the online module

• Evaluation - Solicit feedback on the eLearning modules from preceptors.

eLearning module content

Based on the environmental scan, literature review, workshop findings and working group member expertise, module content focused on the following themes: competencies of a preceptor, setting the stage, competencies of patient-centred collaborative care, teaching strategies, learning styles, managing difficult/challenging situations, feedback and evaluation, models of supervision, and conflict.

Curriculum design and eLearning module structure

AHS HPSP contracted an industry leading curriculum design firm to develop eLearning modules based on the principles of adult learning and the concept of instructional interactivity to capitalize on the potential of eLearning technologies and actively engage the learner's mind. This method of delivering education to preceptors, and others who are interested in precepting or mentoring, will optimize the time learners have to engage in online education.

eLearning module access

Access to the eLearning modules must be available to staff of AHS, its affiliates and partners. For this reason, the eLearning modules content could not be housed within the AHS Learning Management Systems (LMS) and Learning Content Management Systems (LCMS) since, at this time, these can be accessed only via an account linked to an AHS email address. Furthermore, the current AHS learning portal does not support additional learning and knowledge sharing tools such as wikis or blogs. To facilitate availability of the modules, they will be accessed via AHS external HPSP Student Placement webpage. In order to promote the modules within AHS, they will be listed in MyLearningLink (the AHS electronic learning portal) and can be recorded as an external learning event. The modules have been designed so that course material may be moved into the LMS/LCMS if access to AHS LMS/LCMS becomes available to those without an AHS email address.

Piloting and evaluating eLearning modules

Draft eLearning modules will be piloted by volunteer staff who will be asked to provide feedback to the module development team. Changes to the eLearning modules will be done based on the feedback. The eLearning modules are scheduled to go live by January 2012. The first 50 users will be asked to participate in a formal evaluation of the eLearning modules.


Conclusion

The recent formation of AHS and emerging trends in healthcare have created the need to review how practice education is being delivered. This report has summarized the issues with the current state of practice education within AHS and the challenges of implementing IP practice education. It has further highlighted an action plan to innovate practice education within AHS with an interprofessional focus. It outlines strategies which may in the short term be considered for improving the current delivery of practice education and the future implementation of IP practice education. The development of the IP practice education concept design has created a lot of interest and awareness across the province. The creation of eLearning modules is a first step in building an infrastructure to support preceptors. The time is right to move forward with a system-wide IP practice education approach. Champions and partnerships are essential in order to move toward the structures and processes required to implement and maintain IP practice education and collaborative practice in order to optimize patient care within Alberta.

Next steps

The following are the next steps to move IP practice education forward.

• Implement and evaluate eLearning modules

• Validate the concept design components and proposed action plan with appropriate AHS executives and external stakeholders

• Secure executive sponsorship to champion this IP practice education action plan within AHS and its partners

• Develop a working group to implement this IP practice education action plan


References

British Columbia Academic Council, Practice Education Committee. 2008a. Building quality in practice education. Self-assessment checklist for clinical program and service unit leaders in health authorities. http://www.hspcanada.net/docs/quality_indicators/clinicalleaderschecklist.pdf Retrieved September 9, 2010.

British Columbia Academic Council, Practice Education Committee. 2008b. Building quality in practice education. Self-assessment checklist for corporate leaders in health authorities. http://www.hspcanada.net/docs/quality_indicators/corporateleaderschecklist.pdf Retrieved September 9, 2010.

Marshall M, Gordon F. 2005. Interprofessional mentorship: Taking on the challenge. Journal of Integrated Care 13(2):38–43.

Senge PM. 1990. The Fifth Discipline. London: Century Business.

World Health Organization (WHO). 2010. Framework for Action on Interprofessional Education & Collaborative Practice. WHO: Health Professions Network Nursing and Midwifery Office within the Department of Human Resources for Health. http://www.who.int/hrh/nursing_midwifery/en/ Retrieved September 13, 2010.

Appendix A – HPSP IPECP Glossary

Background paper to IP practice education within AHS Feb 1, 2012 version A1

Appendix A Health Professions Strategy and Practice

Interprofessional Education and Collaborative Practice Glossary

The purpose of this glossary is to promote a shared language and meaning of terms used within Alberta Health Services, Health Professions Strategy & Practice portfolio (HPSP). This is not an exhaustive list of terms and the definitions are not meant to be prescriptive. This is a working document and will be continuously updated. Case management: A collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes. (World Health Organization, 2008) Clinical workforce: Health care providers (regulated and non-regulated) involved in delivery of health care services in all AHS sites and settings. See Clinical Workforce Strategic Plan Appendix for a list of occupations included in clinical workforce. (Alberta Health Services, 2011) Collaboration/Collaborative Practice/Interprofessional Collaboration: Note: These three terms are used interchangeably; there are three definitions that are most frequently used in the literature. At this time, the Collaborative Practice and Education Steering Committee (CPESC) has adopted the first definition by Way et al., (2000) for use, but this is being revisited. HPSP agreed that we will adopt whichever definition CPESC adopts to support consistency in terminology. 1) An interprofessional process of communication and decision making that enables the separate and shared knowledge and skills of health care providers to synergistically influence the patient care provided. (Way et al, 2000) Interprofessional in the context of collaboration refers to all individuals associated with patient care including the non-clinical workforce. 2) Occurs when multiple health care providers from different professional backgrounds provide comprehensive services by working with patients, their

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http://en.wikipedia.org/wiki/Patient_advocacy�

Appendix A – HPSP IPECP Glossary Background paper to IP practice education within AHS

Feb 1, 2012 version A2

families, careers and communities to deliver the highest quality of care across settings. (WHO Framework for Action on IE & CP, 2010) 3) A partnership between a team of health care providers and a client in a participatory, collaborative and coordinated approach to shared decision making around health and social issues. (CIHC Framework) Collaborative practice-ready health care provider: A health care provider who has learned to practice with members from other professional backgrounds. (adapted from World Health Organization, 2010) Collaborative practice team: A group of people from different professional backgrounds who deliver services and coordinate care programs in order to achieve different and often disparate service user needs. Goals are set collaboratively through consensual decision making and result in an individualized care plan which may be delivered by one or two team members. This level of collaborative practice maximizes the value of shared expertise and minimizes the barriers of professional autonomy. Often, one team member is appointed as a key worker or case manager for the service user; in this role they coordinate communication between health care providers and the patient or client or carer. The team meets regularly to evaluate outcomes and quality of care delivery. (adapted from World Health Organization, 2008) Competency: A complex process that encompasses the ongoing development of an integrated set of knowledge, skills, attitudes, and judgments enabling one to effectively perform the activities required in a given occupation or function to the standards expected in various and complex environments and situations. (adapted from Canadian Interprofessional Health Collaborative, 2010; McNair, 2005; Pepin et al., 2011; Roegiers, 2007) Continuing professional development: Learning undertaken after initial qualification for a particular job or profession in order to maintain competence and develop capability. It aims to enhance knowledge and improve performance. (Freeth et al., 2005) Continuum of care: The delivery of services across sectors by different health care providers in a coherent, logical, and timely fashion. (Haggerty et al, 2003) Discipline: An academic or clinical field of study, such as psychology or biology, nursing, midwifery and subspecialties within these areas, for example, the



disciplines of anaesthesia or radiology within medicine. (adapted from Freeth et al., 2005) Entry-to-practice competencies: The competencies expected of the new graduate from an approved health profession education program for initial entry-to-practice as a health care provider within their discipline. (adapted from College & Association of Registered Nurses of Alberta, 2006) Health Human Resources (HHR): HHR has been described as the human capital needed to design health care systems and to implement health service delivery models that are cost effective (Health Canada 2011). HHR Outcomes: refer to standard quality of worklife indicators as identified by the Quality Workplace Quality Healthcare Collaborative which includes quality workplace, staff satisfaction, recruitment, retention, turnover and choice of employment (QWQHC, 2007). Integrated care pathways (ICPs): Structured, evidence-based, multi-disciplinary care plans that seek to detail the essential steps required in the care and/or treatment of people. (Davis, 2005) Integration: Services, health care providers, and organizations from across the continuum of care working together so that services are complementary, coordinated, in a seamless unified system, with continuity for the client. (Canadian Council on Health Services Accreditation, 2006) Interprofessional competencies: The complex integration of knowledge, skills, attitudes, values, and judgments that allow a health care provider to apply these components into all collaborative situations. Competencies should guide growth and development throughout one’s life and enable one to effectively perform the activities required in a given occupation or function and in various contexts. (Canadian Interprofessional Health Collaborative, 2010) Interprofessional education (IPE): Bringing together health care providers from different professions to “learn with, from and about each other” to enhance collaboration and the quality of patient care (Centre for the Advancement of Interprofessional Education, 2002). Formal IPE, including debriefs, reflection and evaluation of IP competencies (e.g. role clarity, shared decision-making), are critical to IPE. This is different from incidental (or informal) IP opportunities that lack the intention of IP competency development and hence fail to produce significant IP learning outcomes. (Freeth et al., 2005) Interprofessional



education occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes. (WHO Framework for Action on IE & CP) Interprofessional interventions are different types of activities with professionally diverse providers in any setting to enhance collaborative practice and the quality of care. They are subdivided into 3 different types:

1. Interprofessional education (IPE) interventions occur when two or more professions learn interactively to improve collaborative practice and the quality of care.

2. Interprofessional practice (IPP) interventions are activities or procedures incorporated into regular practice to improve collaborative practice and the quality of care.

3. Interprofessional organizational (IPO) interventions are changes at the organizational level (for example, space, staffing, policy) to enhance collaborative practice and the quality of care.

(Reeves et al. 2011: 169). Interprofessional mentor or facilitator: A health care provider who facilitates, supervises, and evaluates interprofessional learning for students from other disciplines during students' clinical placements. All health care providers, including preceptors, field supervisors, can act as interprofessional facilitators or mentors. (Marshall et al., 2010) Interprofessional peer mentor: An experienced health care provider who provides expertise in the area of collaboration and collaborative practice competencies to less experienced individuals from the same or from other professional backgrounds. Interprofessional practice education: Refers to clinical placements where students have opportunities to learn from professionals from other disciplines to develop collaborative practice skills. Learning organization: Organizations where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free, and where people are continually learning to learn together. (Senge, 1990)



Model of Care: The design of care delivery, which includes clarification of health care provider roles and responsibilities, the philosophy of care (such as patient/family-centred) and the structure of care delivery, such as total patient care, team-based, integrated across the continuum. (Alberta Health Services, 2011) Model of Care and Service Delivery Model: The literature does not clearly distinquish between models of care and service delivery models and in many instances, these terms are used interchangeably. Models of care/service delivery models support delivery of services by the right people, at the right time, in the right way. An effective model of care/service delivery model fully considers population health needs, patient preferences, risk mitigation, continuous improvement, accountability, best practices, sustainability, geographic context, staff, space and financial resources constraints and integration across the continuum of care. Models of care/service delivery models are dynamic and amenable to change to address changing internal and external environments. Within the context of AHS, the term Model of Care is most often used at the micro level (such as an acute care unit or a program), while the term Service Delivery Model refers to larger contexts. Non-clinical workforce: need to get definition from HR Patient/family-centred care: Client (Patient and Family) Centred Care means working in partnership with patients and families by encouraging active participation of patients and families in all aspects of care, as integral members of their health care team, and as partners in planning and improving new facilities and existing services. (J. Rees, Executive Director Patient Experience, AHS, personal communication, January 26, 2012) Practice education: Umbrella term used to describe all aspects of student clinical placements. This type of education is designed to bridge classroom theory and professional practice. (Council of University Teaching Hospitals, 2001) Preceptor: A health care provider that is paired with a student from the same discipline at a specific point of the education program to help the student learn the roles in a particular area of practice. The preceptor supervises and evaluates the student. (Council of University Teaching Hospitals, 2001) Other terms used include supervisor or field supervisor, field instructor, practicum host, field placement host, mentor. (Saskatchewan Academic Health Sciences Network, 2010)



Primary care: First point of contact between individuals and the health care system, typically through a visit to a family doctor. (adapted from College & Association of Registered Nurses of Alberta, 2005; Lewis, 2004; Smith, 2005) Primary health care: Essential health care, based on practical, scientifically sound and socially acceptable methods and technology, made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self reliance and self-determination (World Health Organization, 1978). Primary health care extends beyond the traditional health care system to include services that encompass the determinants of health such as housing, income education and environment. (College & Association of Registered Nurses of Alberta, 2008 Productivity: Productivity is defined as outputs per unit of input with evidence of improved quality and improved health outcomes that contribute to achieving health system goals (Adapted from AHW). Recruitment: Process of finding and selecting staff to fill vacant posts in an organization. (World Health Organization, 2008) Retention of staff: Ensuring that an organization keeps the staff it needs and wants to stay and accepting that inevitably some will leave to work elsewhere. (World Health Organization, 2008) Role clarity: Learners and health care providers understand their own roles and the roles of those in other professions, and use this knowledge appropriately to establish and achieve patient/client/family and community goals. (Canadian Interprofessional Health Collaborative, 2010) Scope of practice: Knowledge and skills acquired through professional education, reflected in legislative authority, described in the practice standards of respective disciplines and demonstrated by all members of a professional group at entry-to-practice. (adapted from College & Association of Registered Nurses of Alberta, 2006) Service Delivery Model: see Model of Care Workforce optimization: The optimal deployment and utilization of all health care providers to achieve a high performing, patient-centred, health system. This



includes matching health care provider skills to patient population health need, and an effective, efficient, and sustainable health care team composition that enables health care providers working to full skill, knowledge and capability within a collaborative practice service delivery model focused on patient, provider and system outcomes. (Alberta Health Services, 2011) Workforce optimization enables organizations to optimize patient outcomes while ensuring the most effective, flexible and cost effective use of human resources. It is the product of multiple, integrated and interacting organizational interventions focused on: (i) appropriate staff mix; (ii) continued education to ensure health service provider continued competency in a changing health system, (iii) optimal deployment of staff members’ competencies; and (iv) optimal practice environments. (Dubois, CA and Singh, D, 2009) Workforce utilization: The organization and deployment of the clinical workforce to optimize their collective ability to work to full scope of practice; in the context of the AHS Clinical Workforce Strategic Plan, utilization embraces the concepts of patient-centred needs-based care, optimal staff mix, collaborative practice, and fiscal responsibility. Reference list Alberta Health Services. 2011. Clinical workforce strategic plan 2011-2016, Appendix 8 Terms and Definitions, Draft. Health Professions Strategy & Practice. Canadian Council on Health Services Accreditation. 2006. CCHSA’s accreditation program: Glossary. Ottawa: CCHSA. Canadian Interprofessional Health Collaborative. 2010. A National Interprofessional Competency Framework. http://www.cihc.ca/ Centre for the Advancement of Interprofessional Education. 2002. Defining IPE. http://www.caipe.org.uk/about-us/defining-ipe/ College & Association of Registered Nurses of Alberta. 2005. Primary Health Care. http://www.nurses.ab.ca/pdf/Primary%20Health%20Care.pdf College & Association of Registered Nurses of Alberta. 2006. Entry-to-practice competencies for the registered nurses profession. http://www.nurses.ab.ca/



Council of University Teaching Hospitals. 2001. Models and best practices in recognizing and supporting preceptors and mentors. http://www.couth.bc.ca, http://www.bcahc.ca/pdf/STRAT-F.pdf Davis, Nicola (ed.). 2005. Integrated care pathways: A guide to goo practice. National Leadership and Innovation Agency for Healthcare. http://www.nliah.wales.nhs.uk Freeth D, Hammick M, Reeves S, Koppel I, Barr H. 2005. Effective Interprofessional Education: Development, Delivery and Evaluation, Blackwell Publishing. Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R. Continuity of care: A multidisciplinary review. BMJ 327:1219-21. Interprofessional Education for Collaborative Patient-Centred Practice. 2006. Research workshop final summary notes. http://www.hc-sc.gc.ca/index-eng.php Lewis S. 2004. A thousand points of light? Moving forward on primary health care. A synthesis of the key themes and ideas from the National Primary Health Care Conference. Winnipeg MB. http://www.eicp.ca/en/resources/pdfs/PHC_Conference_Synthesis_Report.pdf Marshall M, Gordon F. 2010. Exploring the role of the interprofessional mentor. Journal of Interprofessional Care 24(4):362-74. Pepin J, Dubois S, Girard F, Tardif J, Ha L. 2011. A cognitive learning model of clinical nursing leadership. Nurse Education Today 31:268-73. Reeves S, Goldman J, Gilbert J, Tepper J, Silver I, Suter E, Zwarenstein M. 2011. A Scoping Review to Improve Conceptual Clarity of Interprofessional Interventions. Journal of Interprofessional Care 25:167-174. Saskatchewan Academic Health Sciences Network. 2010. Environmental Scan for the Development of a Provincial Preceptor Website, Draft Report. http://www.saskhealthsciencesnetwork.usask.ca/Preceptor/Draft%20Report%20Environmental%20Scan.pdf Senge PM. 1990. The Fifth Discipline. London: Century Business.



Smith D. 2005. Primary Health Care. In Community health nursing – A Canadian perspective. L Lesseberg Stamler & L Yiu (eds). Toronto ON: Pearson Prentice Hall. Way D, Jones L, Busing N. 2000. Implementation strategies: Collaboration in primary care: Family doctors & nurse practitioners delivering shared care. Toronto: The Ontario College of Family Physicians. World Health Organization (WHO). 1978. Declaration of Alma-Ata. International conference on primary health care. http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf World Health Organization (WHO). 2008. Interprofessional Education and Collaborative Practice Glossary. WHO: Study Group on Interprofessional Education and Collaborative Practice. http://cihc.wikispaces.com/Interprofessional+Glossary World Health Organization (WHO). 2010. Framework for Action on Interprofessional Education & Collaborative Practice. WHO: Health Professions Network Nursing and Midwifery Office within the Department of Human Resources for Health. http://www.who.int/hrh/nursing_midwifery/en/

Appendix B

Building capacity for clinical placements through interprofessional preceptor

development and support

November 30, 2010 Stakeholder workshop report

Prepared by:

Health Professions Strategy & Practice Health Systems and Workforce Research Unit

Esther Suter

Gail D Armitage

January 27, 2011

Appendix B – Stakeholder workshop report Building capacity for clinical placements through

interprofessional preceptor development and support January 27, 2011

Page Bi

Acknowledgements We would like to acknowledge:

Workshop attendees who shared their experiences and contributed to the ongoing development of the concept design and learning modules

Project working groups, Advisory Committee and Steering Committee for their vision and support of IP practice education

Alberta Health and Wellness, Health Workforce Action Plan, for financial contribution to this project (see Disclaimer)

Disclaimer The findings presented in this report do not necessarily reflect the opinions or policies of Alberta Health and Wellness.



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Executive Summary Health service provider education has both academic and practice components and students can expect to spend between 30 to 50 percent of their education in practice settings. A recent scan of Alberta Health Services (AHS) and its former entities found few programs to educate and support preceptors and no consistency among the programs. AHS is responsible for the majority of practice education across the province and there is a need for a standardized approach. AHS, Health Professions Strategy and Practice received funding from Alberta Health and Wellness, Health Workforce Action Plan to develop a preceptor training, development and support program that is sustainable, accessible, improves the quality of the interprofessional (IP) practice education experience and fosters collaborative practice. It will be evidence-based and grounded in best practice. Benefits may include: i) increased capacity for student placements in urban and rural Alberta, ii) increased number of preceptors providing students with positive, interprofessional practice education experiences, and iii) strategic concepts that support a comprehensive practice education infrastructure and processes including aspects of planning, culture, quality and operations. The project deliverables are a concept design outlining how AHS may advance a high quality interprofessional practice education and support program, and on-line learning modules to provide preceptors of healthcare students with the required skills and knowledge to provide them with a positive practice education experience. Stakeholders from educational institutions, government departments and AHS were invited to attend a full-day workshop to review and provide critical feedback on the concept design and on-line learning module content material. The event was the first step to engaging the numerous partners across Alberta involved in practice education and to start the dialogue around a future common vision. Learnings from the workshop attendees Workshop participants agreed there was a need to develop a common vision around IP practice education and preceptor development and support. This was seen as a way to move from pockets of excellence to a system-wide culture that fosters IP education and practice for the benefit of the patient. Participants stressed the importance that everyone involved in practice education be “on the same page” and that organizational support from all levels was essential. Participants further saw the need to ground the IP practice education program in a culture of collaboration and innovation where partners work together to increase the quality of patient care. Concept design The concept design (Appendix 2) appeared to capture the essential areas to be considered for further development of an IP practice education strategy. (See Appendix 1 for background information about the development of the concept design.) Some participants suggested a circular model rather than boxes to avoid creating silos. It was stressed that the concepts need to be applicable to any type of practice context. Workshop participants identified areas of focus for advancing IP practice education in AHS. Stakeholder engagement - The key point emerging from the workshop was that we strongly focus on engaging all partners that have a stake in interprofessional practice education and preceptor training. A number of groups were identified including regulatory bodies, professional bodies, physicians, patients/families, Primary Care Networks and contracted organizations. Communication - The importance of communication was stressed during the workshop discussions. Some of the key topics and suggestions for going forward were a common vision of IP practice education, development



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of communication strategies for stakeholder groups, dispelling myths around IP, and avoiding discipline/profession specific terms. Culture - Creating a culture that supports IP practice education is paramount. It must be evident throughout the organization that IP education and IP practice are strong values, supported and promoted at all levels of the organization. Strategic plan, policies, organizational learning strategy and leadership development - A strategic plan supported by policies and an organizational learning strategy were considered to be essential for the successful planning and implementation of the IP practice education program. A number of areas were mentioned for consideration in strategic planning and policy development including incorporation of IP education in strategic plans and policies, expectations of academic, professionals, and regulatory stakeholders, and direction to management and front line staff for IP practice education. Infrastructure and resources - Infrastructure and resources to support IP practice education were also discussed by workshop participants. There was agreement that substantial and ongoing funding will be required to develop the infrastructure and essential supports at multiple levels. Some of the specific concerns were related to technology, space, and patient information and documentation systems. Quality assurance - There was agreement on the importance of ongoing monitoring to ensure high quality of the IP practice education program. It was suggested that performance measures should be at the unit level and publicly accessible, and be fed back into the system. IP practice education model - Client/family-centred care and quality outcomes should be foundational to the model which builds on existing best practice models and evidence from the literature. Support - IP practice education and preceptor development require support mechanisms. Suggestions included rewards for preceptors, recognition of the roles managers and unit colleagues have in a successful IP practice education program, and methods for those involved in IP practice education to share learnings and experiences, exchange ideas or ask questions. Learning modules Content - Overall, attendees considered the on-line learning module content to be comprehensive but offered some suggestions for material and presentation. These included stressing the importance of role modeling both the discipline’s scope of practice and collaborative IP practice, helping preceptors recognize teachable moments and providing them with the tools to make the most of them, emphasizing the benefits of precepting, and ensuring practice education content does not conflict with educational institute curriculum. Presentation - The ideal learning modules will be short (10-20 min), engaging and interactive. The user should be quizzed and clarifications for incorrect answers provided. Preceptors benefit from opportunities for face-to-face or group learning to practice IP precepting and communication. Next steps The Concept Design Working Group (CDWG), based on feedback from the workshop participants, will continue to develop the concept design. Subsequent to clarification of the project vision and deliverables, the CDWG will engage with workshop participants and other partners to collaborate with us in the continuing development of the concept design and areas of focus.



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Table of contents 1. Background .................................................................................................................................................... B1

2. Project description and deliverables .............................................................................................................. B1

3. November 30, 2010 workshop ....................................................................................................................... B2

3.1. Summary of workshop findings ............................................................................................................... B2

3.1.1. Concept design ......................................................................................................................... B2

3.1.2. Learning modules ...................................................................................................................... B6

4. Next steps ...................................................................................................................................................... B7

References ........................................................................................................................................................... B8

Appendix 1 – Definitions and Concept design background ................................................................................. B9

Appendix 2 – Concept design ............................................................................................................................ B10

Appendix 3 - Workshop agenda ......................................................................................................................... B11

Appendix 4 – Workshop evaluation .................................................................................................................... B12

Appendix 5 – Project participant survey form .................................................................................................... B16



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1. Background Health service provider education has both academic and practice components and students can expect to spend between 30 to 50 percent of their education in these practice education settings. A recent scan of Alberta Health Services (AHS) and its former entities found few programs to educate and support preceptors and no consistency among the programs. AHS is responsible for the majority of practice education across the province and there is a need for a standardized approach to practice education and preceptor development and support with AHS. A conservative estimate for total number of preceptors needed in AHS annually to provide students with positive practice education opportunities is 6000, highlighting the scale of the practice education needs. Students who come to AHS for practice learning are the single greatest resource for the future to provide healthcare for the people of Alberta. Research shows that students who have positive practice education experiences are more likely to return to an organization as employees. There are a number of important factors in providing students with positive learning experiences including preceptors and other health professionals in the placement site who are supportive and provide the student with systematic opportunities to experience collaborative practice with an interprofessional team, integration into the team, and an environment and organizational culture of support for interprofessional (IP) practice education. All these result in a culture of interprofessional practice education development and support which strengthens health systems and improves health outcomes. Interprofessional education occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes. Interprofessional education is a necessary step in preparing a “collaborative practice-ready” health workforce that is better prepared to respond to local health needs. A collaborative practice-ready health worker is someone who has learned how to work in an interprofessional team and is competent to do so. Collaborative practice happens when multiple health workers from different professional backgrounds work together with patients, families, carers and communities to deliver the highest quality of care. It allows health workers to engage any individual whose skills can help achieve local health goals. (World Health Organization, 2010) See Appendix 1 for additional definitions.

2. Project description and deliverables AHS, Health Professions Strategy and Practice has received funding from Alberta Health and Wellness, Health Workforce Action Plan (HWAP) to develop a preceptor training, development and support program that is sustainable, accessible, improves the quality of the interprofessional practice education experience and fosters collaborative practice. It will be evidence-based and grounded in best practice. Benefits may include: i) increased capacity for student placements in urban and rural Alberta, ii) increased number of preceptors providing students with positive, interprofessional practice education experiences, and iii) strategic concepts that support a comprehensive practice education infrastructure and processes including aspects of planning, culture, quality and operations. The project deliverables are a concept design (Appendix 2) outlining how AHS may advance a high quality interprofessional practice education and support program, and on-line learning modules to provide preceptors of healthcare students with the required skills and knowledge to provide them with a positive practice education experience. Two AHS inter-departmental teams were created to undertake these deliverables. The Concept Design Working Group is developing a draft concept design (Appendix 1 for Background and Appendix 2 for Concept



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design) that outlines strategic concepts to support infrastructure and processes for IP practice education. It includes aspects of planning, culture, quality and operations. The Learning Modules Working Group is facilitating the development, implementation and evaluation of on-line learning modules for interprofessional preceptors. 3. November 30, 2010 workshop Stakeholders from educational institutions, government departments and AHS were invited (n = ≈ 350) to attend a full-day workshop to review and provide critical feedback on the concept design (Appendix 2), and on-line learning module content material. The event was hosted at three sites (Lethbridge, Calgary and Edmonton) connected online to allow for broader participation. It was the first step to engage the numerous partners across Alberta involved in practice education and to start the dialogue around a future common vision. The objectives of the workshop were:

1. Share current and emerging approaches to preceptor education and support across the western provinces Validate a draft concept design for IP practice education

2. Identify the structures, processes and people relevant for preceptor education and support Identify gaps in the concept design Reach consensus on core components for successful and sustainable preceptor education and

support Draft high level strategies for the development, implementation and evaluation of concepts outlined

in the design 3. Review and provide feedback on a draft interprofessional preceptor learning module

(See Appendix 3 for a summary of the workshop agenda and Appendix 4 for the workshop evaluation.) 3.1. Summary of workshop findings Workshop participants agreed there was a need to develop a common vision around IP practice education and preceptor development and support. This was seen as a way to move from pockets of excellence to a system-wide culture that fosters IP education and practice for the benefit of the patient. Participants stressed the importance that everyone involved in practice education be “on the same page” and that organizational support from all levels was essential. Participants further saw the need to ground the IP practice education program in a culture of collaboration and innovation where partners work together to increase the quality of patient care. 3.1.1. Concept design The concept design (see Appendix 2) appeared to capture the essential areas to be considered for further development of an IP practice education strategy. Some participants suggested using a circular model rather than boxes to avoid creating silos. Others pointed out redundancies or inconsistencies within the concepts. It was stressed that the concepts need to be applicable to any type of practice context. Participants identified the following areas of focus.



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Stakeholder engagement The key point emerging from the workshop was that we strongly focus on engaging all partners that have a stake in interprofessional practice education and preceptor training. The following stakeholder groups were identified: Academics, Educational institutions Regulatory bodies Professional bodies Frontline staff Government departments including education Healthcare providers from all disciplines Physicians Patients/families Students Primary Care Networks Contracted organizations

It was noted that some of these voices were missing at the workshop, in particular the professional and regulatory bodies. Early engagement was seen as important for buy-in and ongoing support of the program. A strong desire was evident to develop this program in partnership with the numerous stakeholders. There is a need to clarify the roles and expectations of each stakeholder group and the process of engagement. Furthermore, appropriate structures need to be created that allow ongoing dialogue and feedback. Creating a community of practice around IP practice education might be a consideration. There was also a suggestion that the IP preceptor learning modules be available to all AHS partners.

Communication The importance of communication was stressed during the workshop discussions. Some of the key topics and suggestions for going forward were: Articulate a clear common vision around IP practice education and preceptor education and support Devise a common IP language; avoid profession-specific terms Develop a communication strategy and mechanisms specific to the different stakeholder groups Take more of a business approach with marketing Dispel myths around IP (e.g. loss of practice autonomy) Communicate clearly the expectations for preceptors, students, staff and other key members involved

in IP practice education

Culture Creating a culture that supports IP practice education was seen as crucial for the program. It must be evident throughout the organization that IP education and IP practice are strong values, supported and promoted at all levels of the organization. Currently, there is no firm endorsement of collaborative practice models of service delivery or clear standards and policies to support collaborative practice. Many health providers lack the knowledge and skills to work effectively in IP teams and opportunities for IP education are lacking. Quite often students see discrepancies between what they are being taught and expected to do and what they see in practice. The work environment has to allow time and space to engage everybody in IP practice education.



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Strategic plan, policies, organizational learning strategy and leadership development A strategic plan supported by policies and an organizational learning strategy were considered to be essential for the successful planning and implementation of the IP practice education program. Furthermore, participants agreed that such a program could only thrive if a strong IP education and practice culture permeates participating organizations and participation in IP practice education is a clear expectation. The following areas were mentioned for consideration in strategic planning and policy development: Expectations of academic, professional, and regulatory stakeholders Direction to management and front line staff for IP practice education Standards for preceptor selection and evaluation Incorporation of IP education in strategic plans and policies Regulated competencies to support operations, that is, preceptor valuation, standards of practice Job descriptions that contain participation in practice education as an expectation

Such policies will need to be developed and evaluated collaboratively. It was also pointed out that strategies implemented in AHS need to align with strategies at the education level, for example, if IP education is an essential component within AHS it will also need to be embedded into undergraduate curricula at the higher education institutions. Suggestions for the organizational learning strategy focused on the following elements: Learning strategy that values relationships as a core principle and builds on adult learning principles Support all preceptors within AHS, regardless of discipline Develop modules not just for preceptors but for all employees to support their contribution to promoting

IP practice education Start with students now as they are the preceptors of tomorrow Integrate “old” concepts such as family-centred care Focus on role clarification (e.g. know when to refer and to whom) Consider preceptor certification associated with a 3-4 month preceptor program

Workshop participants highlighted the need for leadership support at all levels to successfully plan and implement an IP practice education program. This may require development of leaders and champions to help with a consistent vision and communication across the organization. There was acknowledgment of the challenging environment which makes clear, concise and well defined communication from AHS corporate leaders and clinical program and service unit leaders more important.

Infrastructure and resources Infrastructure and resources to support IP practice education were also discussed by workshop participants. Funding was a concern for many of them. There was agreement that substantial and ongoing funding will be required to develop the infrastructure and essential supports at multiple levels. More specific concerns related to the following areas: Technology: many practice education areas do not have enough (or any) computers to allow effective

education of staff, preceptors and students; current technology (e.g. simulation) are not fully exploited for IP education purposes; geographic challenges (e.g. lack of access to internet and provincial network especially in remote areas); support users with limited experience with e-learning

Space: most practice education settings have space constraints; there is a lack of dedicated space for student/staff/preceptor education; space needs to be facilitated and utilized in an efficient manner



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Staff and preceptor learning modules: funding is required to develop user friendly modules and keep them up-to-date

Patient information/documentation systems: current systems do not necessarily support IP practice; not everybody has access to the system. There were suggestions for IP charts, care pathways with input from all levels, IP rounds and to measure outcomes for common identified goals

Knowledge sharing takes time: time constraints reduce staff opportunities to share experiences and information with students and colleagues

Logistics to manage IP practice education across such a big organization: human resources support, technology, funding, time to phase in

Consider local infrastructure and resource needs (e.g. rural areas may have different needs than urban centres)

Quality assurance

There was agreement on the importance of ongoing monitoring to ensure high quality of the IP practice education program. It was suggested that performance measures should be at the unit level and publicly accessible, and be fed back into the system. However, it seemed to be less clear what needs to be monitored and how. Some suggestions were: Clearly identify desired outcomes Conduct a baseline measure of where we are with IP education and practice Measure exposure to IP concepts and how it changes over time Focus on patient outcomes to avoid practice silos Include willingness to preceptor into formal evaluation of staff Identify selection criteria and standards for preceptors Assess units on the IP learning opportunities for students Evaluate to what extent preceptors, staff and instructors/faculty are engaged in IP practice education Develop tools for preceptors to determine level of student skill Consider some form of accreditation for IP practice placement settings Use the extent to which health providers understand each other’s roles as a measure of quality

IP practice education model

Some of the discussions focused on what the actual IP practice education model would look like. Participants suggested we need to have a sound model that builds on existing best practice models and evidence from the literature. Attention will need to be paid to terminology (mentor vs supervisor vs preceptor vs guide) as some of these terms have a particular meaning to regulatory bodies and in the business and health literature. Client/family-centred care and quality outcomes should be foundational to the model. Some elements to be considered for the IP practice education model are: Supervise from a distance Practice One Minute Preceptor teaching method Relationship building with dyads (preceptor + student) IP approach to patient care should be integrated throughout model Precept regardless of clinical/practice context Clarify language including differences / common understanding about what an IP preceptor is Consider non-traditional rotations Facilitate students’ opportunities to shadow other healthcare professions (e.g. nursing student shadows

social worker)



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Focus on peer mentoring and role modeling Promote reflective practice Welcome students from all professions Include new graduates in the model Identify requirements for an IP environment (e.g. staff mix)

Support

IP practice education and preceptor development require support mechanisms. Suggestions for support of preceptors, staff and managers included: Rewards for preceptors as important incentives to attract new preceptors and retain those already in

the system; incentives could be associated with career development opportunities, financial reimbursement or work relief time; there were suggestions that preceptors be a paid position between AHS and post-secondary institutions

It was recognized that managers play a critical role in creating an environment that facilitates IP practice education and will need to be supported accordingly

Frontline staff have a role in successful IP practice education; their contribution should be recognized and learning opportunities such as bridging programs made available

Preceptors benefit from a “buddy” system, online chats, or Ask An Expert message boards to share learnings and experiences, exchange ideas or ask questions

IP courses in the practice setting that enable engagement of the entire healthcare team in learning to work collaboratively to achieve improved patient care

3.1.2. Learning modules Overall, attendees considered the on-line learning module content to be comprehensive and offered the following suggestions.

Content Topics the workshop participants highlighted for inclusion in the learning modules included: Role modeling both the discipline’s scope of practice and collaborative IP practice Role of preceptor to both evaluate student’s skills and educate the student; modules should prepare

preceptors to recognize and make the most of teachable moments, provide feedback, support struggling or good students, and facilitate the student’s IP learning opportunities; tools to aid the preceptor understand learning styles and adult learning principles should also be included in the modules

Stress the benefits of being a preceptor, for example, skills involved in being a good preceptor are transferable to other areas of being a good professional; being a good preceptor also means the preceptor and student grow together

Ensure practice education content does not conflict with educational institution curriculum; remind preceptors to look for course syllabus and to contact the faculty member who can answer questions about their student’s placement; dialogue with the student about expectations should occur early

Caution should be used when providing material about generational differences since it may promote stereotypes, furthering negative connotations associated with perceived generational differences

E-tips, summary section or printable pages should be included; possibly a toolkit the user can “take away” from the modules

Operational items such as designing rotations for the student and tips on orienting students to the unit would be helpful; preceptor should ensure the practice education setting is a safe place for students



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Presentation

How the material is presented was also discussed. Attendees considered ideal learning modules will be short (10-20 min), engaging and interactive. The user should be quizzed and clarifications for incorrect answers provided. Modules can be done in any order. In addition to the on-line learning modules, preceptors would benefit from face-to-face or group (e.g. webinars, telehealth, discussion boards) learning opportunities to practice IP precepting and communication. These opportunities need to be ongoing to support preceptors continued development and education. Provide alternative formats (e.g. paper binders, CD / DVD) for users with no or limited access to the web.

4. Next steps The Concept Design Working Group (CDWG), based on feedback from the workshop participants, will continue to develop the concept design. Subsequent to clarification of the project vision and deliverables, the CDWG will engage with workshop participants and other partners to collaborate with us in the continuing development of the concept design and areas of focus.



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References Andrews GJ, DA Brodie, JP Andrews, J Wong, BG Thomas. 2005. Place(ment) matters: Students’ clinical experiences and their preferences for first employers. International Nursing Review 52:142-53. Buring SM, A Bhushan, A Broeseker, S Conway, W Duncan-Hewitt, L Hansen, S Westberg. 2009. Interprofessional education: Definitions, student competencies, and guidelines for implementation. American Journal of Pharmaceutical Education 73(4):Article 59. Council of University Teaching Hospitals. 2001. Models and Best Practices in Recognizing and Supporting Preceptors and Mentors. Vancouver: Council of University Teaching Hospitals. Retrieved from www.couth.bc.ca on September 27, 2010. Senge PM. 1990. The Fifth Discipline. London: Century Business. World Health Organization (WHO). 2010. Framework for action on interprofessional education & collaborative practice. Geneva, Switzerland: WHO, Health Professions Network Nursing and Midwifery Office within the Department of Human Resources for Health. Retrieved from http://www.who.int/hrh/resources/framework_action/en/index.html on October 22, 2010. Zwarenstein M, J Goldman, S Reeves. 2009. Interprofessional collaboration: Effects of practice based interventions on professional practice and healthcare outcomes. The Cochrane Database of Systematic Reviews (3).



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Appendix 1 – Definitions and Concept design background

Building Capacity for a High Quality Interprofessional Preceptor Education and Support Program

Funded by AB Health & Wellness, Health Workforce Action Plan

Background Document for Interprofessional Practice Education Concept Design

The recent formation of AHS has created the need to review how practice education is being delivered. The former health authorities each had different ways to organize and deliver practice education and to prepare preceptors for their roles. Now with Alberta Health Services being responsible for practice education across the province, there is a need for a standardized approach to practice education and preceptor development. A conservative estimate for total number of preceptors needed in AHS annually would be 6000, highlighting the scale of the practice education needs. Current issues with practice education (from preceptor, student, staff, organizational perspective) Based on the literature and validated by practice experience, we are aware of a number of issues with current practice education.

• There are not enough preceptors available to supervise students; often preceptors are not well enough qualified and lack the support needed to be a high quality interprofessional mentor

• There is increasing demand for clinical placements with overall increasing enrolment in health sciences disciplines • Some practice settings across the continuum of care are not being fully used for clinical placements (e.g. PCNs, Contracted

agencies such as long term care centres and other organizations) • Technology is not fully leveraged to plan, implement and deliver practice education (e.g. HSPnet used inconsistently across

AHS) • Practice education is discipline specific with little attention paid to opportunities to learn with from and about each other and to

collaborate

Objective of this work

The objective of this work is to develop a concept design for high quality interprofessional practice education within Alberta Health Services.

The attached draft concept design is broadly based on the Building Quality in Practice Education, Self Assessment Tools produced by the Practice Education Committee of the British Columbia Academic Health Council (2008) www.hspcanada.net. The concept design outlines strategic concepts that support a comprehensive practice education infrastructure and processes. It includes aspects of planning, culture, quality and operations.

The visual depiction of the concepts allows representing and organizing knowledge in a meaningful way to facilitate further development of the concepts and more specific strategies. There is an inherent interdependency among and between concepts.

The concept design is intended to expand and standardize the organization’s understanding of interprofessional practice education issues and opportunities, and support more systematic and strategic management of interprofessional practice education. We concur with our BC colleagues that interprofessional practice education is a strategic issue for health care organizations and improved capacity for student practice learning is of critical importance to health human resources development for the future (BC Academic Health Council, 2008).

Definitions of terms • Interprofessional education: involves educators and learners from 2 or more health professions and their foundational

disciplines who jointly create and foster a collaborative learning environment. The goal of these efforts is to develop knowledge, skills and attitudes that result in interprofessional collaborative behaviours and competence (Buring, 2009).

• Collaborative practice: the process in which different professional groups work together to positively impact healthcare (Zwarenstein, Goldman & Reeves, 2009).

• Practice education: practice education is an umbrella term used to describe all aspects of student clinical placements and is designed to bridge classroom theory and professional practice (Council of University Teaching Hospitals, [CUTH] 2001).

• Preceptor: a health care provider that is paired with a student from the same discipline at a specific point of the education program to help the student learn the roles in a particular area of practice. The preceptor supervises and evaluates the student. (Council of University Teaching Hospitals, [CUTH] 2001).

• Interprofessional mentor: a health care provider who creates interprofessional learning opportunities for students from other disciplines during students' clinical placements. All health care providers, including preceptors, can act as interprofessional mentors.

• Collaborative practice-ready health worker: a health care providers who has learned how to work in an interprofessional team and is competent to do so (WHO, 2010)

• Learning organization - Organizations where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free, and where people are continually learning to learn together (Senge, 1990, p.3)

http://www.hspcanada.net/�



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Appendix 2 – Concept design



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Appendix 3 - Workshop agenda Dianne MacGregor, Executive Director, Interprofessional Education, welcomed the attendees and set the stage for the day. Presentations by leaders in the field who have been involved in the design and/or implementation of innovative interprofessional practice education programs across the western provinces aimed to stimulate discussions around what the future of interprofessional practice education and collaborative practice might look like in AHS. Members of the project working groups presented on the learning modules and concept design. Presenters: Cathy Rippin-Sisler - Academia and practice: A partnership that works

Regional Director, Clinical Education and Continuing Professional Development, Winnipeg Regional Health Authority

Debbie McDougall - Children’s and Women’s Health Centre of BC, Preceptor Internship Program

Senior Leader, Clinical Education, Learning and Development, BC Women's Hospital and Health Centre Linda Ferguson - Creating a program for preceptorship preparation and valuing

Professor and Director of Centre for the Advancement of the Study of Nursing Education and Interprofessional Education, College of Nursing, University of Saskatchewan

Susan Sommerfeldt, Sylvia Barton – Three perspectives of interprofessional clinical learning: How is this

different from what we already do? Faculty of Nursing, University of Alberta

Katherine Bennett – HWAP preceptor project: Learning modules (Learning Modules Working Group)

Education Consultant – Allied Health, Professional Practice & Development, Health Professions Strategy & Practice, AHS

Esther Suter – HWAP preceptor project: Concept design (Concept Design Working Group)

Senior Research and Evaluation Consultant, Health Systems & Workforce Research Unit, Health Professions Strategy & Practice, AHS

The afternoon was dedicated to providing feedback on the draft concept and the learning module material. This was done in small group discussions using a World Café format (http://www.theworldcafe.com). In the final part of the afternoon, we summarized the deliberations and key comments made for each of the concepts and the learning modules.



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Appendix 4 – Workshop evaluation A total of 87 people (Calgary n=38, Edmonton n=30, Lethbridge n=19) attended the all day workshop on November 30, 2010. Evaluation survey response rates in Calgary (71.1%) and Edmonton (73.3%) were satisfactory. Initially, the Lethbridge response rate was only 36.8%. A number of factors may have contributed to this especially travel conditions (blowing snow, limited visibility) which resulted in a number of participants leaving before the end of the workshop when the surveys were distributed. In order to garner additional comments about the workshop, an electronic survey (created within SurveyMonkey) was emailed to only Lethbridge attendees. This resulted in an additional three surveys for a response rate of 52.6%. (See Table 1, page 13) Those workshop participants completing an evaluation form represented Alberta Health Services (40.7%), education (44.1%), government (6.8%), research (5.1%), and other (3.4%). The other category included students and respondents who held dual appointments. Participant’s roles were diverse including students, program chairs, frontline staff, clinical educators, faculty and instructors from educational institutes, student placement coordinators, physicians and unit managers. A number of disciplines were represented such as nursing, pharmacy, and allied health. Morning presentations (Table 3, page 14) Overall, respondents considered the morning presentations relevant (92.9%) and promoted thinking about the concept design (77.6%) and learning modules (70.2%). They also reported learning something about IP practice education (70.2%). However, several respondents disagreed/strongly disagreed (24.1%) or were neutral (15.5%) when asked if there was sufficient time for questions and discussion of the presentation material. Written comments included suggestions that a longer post-presentation discussion period or some question-and-answer time after each presentation would have benefited attendees. Afternoon breakout discussion sessions aka World Café (Table 4, page 14) Response to the breakout discussion session was quite positive with most respondents agreeing the afternoon break-out sessions were relevant (87.7%), they learned something about IP practice education (74.5%), the World Café format facilitated sharing and developing ideas (91.1%) and there was sufficient opportunity for questions and comments (83.9%). However, there were also written comments that the discussions during World Café went off topic. All participant wrap-discussion (Table 5, page 14) Overall, the evaluation survey respondents found the all participant wrap-up session to be relevant (82.0%). However, fewer respondents agreed or strongly agreed they learned something useful about IP practice education (63.3%) or there was enough time for questions or comments (68.1%). Overall workshop feedback (Table 6, page 15) The majority of survey respondents indicated attending the workshop was a good use of their time (80.7%), they would consider attending another workshop like it (83.9%) and the workshop met their expectations (85.7%). Furthermore, most survey respondents indicated the ideas and suggestions shared were applicable to their organization (83.9%). Actions that evaluation respondents stated may be taken based on workshop learnings can be grouped into those the individual will undertake to change their own practice (e.g. be actively involved in the development of the concept design or learning modules, lead by example) and those which will involve others (e.g. share



Page B13

workshop material and learnings with colleagues and managers, actively promote IP practice education and collaborative practice on the unit). Follow-up information requested by evaluation respondents were a report of the workshop findings (including more background information such as the project vision, mandate, goals), project progress reports, and clarity of definitions and project resources. Evaluation respondents were clear that more communication and engagement of stakeholders, both within AHS (e.g. clinical program and service unit leaders, corporate leaders) and outside (e.g. regulatory bodies, educational institutes) was essential, though some respondents advised caution and a need for clarity of AHS purpose prior to wider distribution. Suggestions included presentations to senior management and executives to seek buy-in for support and resources, stakeholder consultation meetings, workshop highlights document distributed to government, deans of educational institutes’ health programs and regulatory bodies. Communication methods suggested were email, project website, online community of practice, article in Interchange (the AHS internal newsletter), newsletter, provincial telehealth meeting or word of mouth. Evaluation respondents reminded the project working group members of some important points and made the following suggestions and points to keep in mind:

Explicitly state that purpose of IP practice education and collaborative practice is excellent patient care for Albertans

Acknowledge that one of the goals of IP preceptor online learning modules should be a sustainable workforce

Recognize that rural and remote Alberta needs and resources are quite different from urban centres, ensure these differences are addressed with the learning modules, concept design

Engage ALL stakeholders Communicate, communicate, communicate

Table 1 – Number of workshop attendees and survey response rate by site

Table 2 – Area of representation of evaluation respondents (%)

Calgary Edmonton Lethbridge Total

Number of attendees 38 30 19 87

Surveys returned 27 22 10 5971.1% 73.3% 52.6% 67.8%

Count Calgary Edmonton Lethbridge Total

AHS 13 7 4 24 (40.7%)

Education 9 12 5 26 (44.1%)

Government 0 3 1 4 (6.8%)

Other 2 0 0 2 (3.4%)

Research 3 0 0 3 (5.1%)

Total 27 22 10 59 (100.0%)



Page B14

Table 3 – Presentations during morning session (%) Presentations Strongly

Disagree Disagree Neutral Agree Strongly

Agree Total

These presentations were relevant to me

1 (1.8) 0 (0.0) 3 (5.4) 35 (62.5) 17 (30.4) 56 (100.0)

I learned something useful about IP practice education

3 (5.2) 4 (7.0) 10 (17.5) 28 (49.1) 12 (21.1) 57 (100.0)

The presentations helped me think about the concept design

2 (3.4) 5 (8.6) 6 (10.3) 29 (50.0) 16 (27.6) 58 (100.0)

The presentations helped me think about the learning modules

3 (5.3) 7 (12.3) 7 (12.3) 27 (47.4) 13 (22.8) 57 (100.0)

There was enough time for questions and discussion

5 (8.6) 9 (15.5) 9 (15.5) 29 (50.0) 6 (10.3) 58 (100.0)

Table 4 – Breakout discussion session during the afternoon (%)

Break-out discussion session Strongly Disagree

Disagree Neutral Agree Strongly Agree

Total

This session was relevant to me 2 (3.5) 1 (1.8) 4 (7.0) 33 (57.9) 17 (29.8) 57 (100.0)


3 (5.5) 4 (7.3) 7 (12.7) 31 (56.4) 10 (18.2) 55 (100.0)

The World Café discussion process facilitated sharing and developing ideas

2 (3.6) 1 (1.8) 2 (3.6) 24 (42.9) 27 (48.2) 56 (100.0)

There was enough opportunity for my questions and comments

3 (5.4) 3 (5.4) 3 (5.4) 26 (46.4) 21 (37.5) 56 (100.0)

Table 5 – Workshop wrap up session at the end of the day (%)

All participant wrap-up discussion

Strongly Disagree

Disagree Neutral Agree Strongly Agree

Total

This discussion was relevant to me

2 (4.0) 4 (8.0) 3 (6.0) 29 (58.0) 12 (24.0) 50 (100.0)


3 (6.1) 5 (10.2) 10 (20.4) 23 (46.9) 8 (16.3) 49 (100.0)

There was enough opportunity for my questions and comments

1 (2.1) 4 (8.5) 10 (21.3) 24 (51.1) 8 (17.0) 47 (100.0)



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Table 6 – Overall workshop feedback (%) Overall workshop feedback Strongly

Disagree Disagree Neutral Agree Strongly

Agree Total

Attending a workshop like this is a good use of my time

1 (1.8) 3 (5.3) 7 (12.3) 31 (54.4) 15 (26.3) 57 (100.0)

The ideas and suggestions shared will be applicable to my organization

1 (1.8) 1 (1.8) 7 (12.5) 33 (58.9) 14 (25.0) 56 (100.0)

I would consider attending another workshop like this

1 (1.8) 1 (1.8) 7 (12.5) 28 (50.0) 19 (33.9) 56 (100.0)

The workshop was well organized 1 (1.8) 0 (0.0) 4 (7.0) 31 (54.4) 21 (36.8) 57(100.0)

The pace of the workshop was appropriate

1 (1.9) 3 (5.6) 5 (9.3) 31 (57.4) 14 (25.9) 54 (100.0)

The workshop material (e.g. presentations, draft concept design, draft learning module content) was useful

2 (3.6) 2 (3.6) 7 (12.7) 31 (56.4) 13 (23.6) 55 (100.0)

The facilitation was effective 2 (3.5) 1 (1.8) 7 (12.3) 33 (57.9) 14 (24.6) 57(100.0)



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Appendix 5 – Project participant survey form Thank you to everyone who attended the workshop and completed the evaluation survey. Many of you indicated an interest in contributing to this project. While there were several areas of focus identified by workshop participants, two areas have been assigned highest priority: Partner engagement and communication strategy, and Preceptor education and support. This is your opportunity to indicate which areas are of most interest and your level of engagement. Please include your name, title, department and contact information in the form below. Email or fax the completed form to my attention. Also, please feel free to distribute this report and survey form within your professional network with an invitation to contact me for further information or to be added to the partner list. Please contact me if you have any questions about the project or involvement in the working groups. Thanks for your interest.

Areas of focus Participate in working group Provide feedback

1. Partner engagement and communication strategy

2. Preceptor education and support Your name and contact information

Name

Title

Department

Organization

Phone

Email Partners we should contact about IP practice education

Name

Title

Department

Organization

Phone

Email

Please return via your preferred method by Tue Feb 15, 2011 to: Gail D Armitage

Alberta Health Services, Health Systems and Workforce Research Unit fax: 403-943-2875

email: [email protected]

mailto:[email protected]�

Appendix C

CURRENT ISSUES IN INTERPROFESSIONAL PRACTICE EDUCATION

Background paper to

Interprofessional Practice Education within Alberta Health Services

Prepared by

Health Systems and Workforce Research Unit Health Professions Strategy and Practice

Alberta Health Services

AUGUST 2011

Appendix C – Current issues in IP practice education Background paper to IP practice education within AHS

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Acknowledgements Understanding practice education within Alberta and developing a proposed plan for moving interprofessional (IP) practice education forward within Alberta Health Services (AHS) was achieved with the help of our colleagues and partners within and outside AHS. Members of the project Steering Committee, Advisory Committee, Concept Design Working Group, and Learning Modules Working Group, as well as the participants at a workshop to discuss IP practice education and members of numerous working groups who identified the current state of practice education within Alberta and proposed strategies for future possibilities of IP practice education represented the following organizations:

Education partners - Athabasca University, Bow Valley College, Grande Prairie Regional College, Grant MacEwan University, Lethbridge College, Medicine Hat College, Mount Royal University, Norquest College, Red Deer College, University of Alberta, University of British Columbia, University of Calgary, University of Lethbridge, University of Manitoba, University of Saskatchewan

Government partners - Alberta Advanced Education, Alberta Health and Wellness

Health organization partners - Alberta Health Services, British Columbia Children's and British Columbia Women's Hospitals, British Columbia Provincial Health Services Authority, Saskatoon Health Region, Winnipeg Regional Health Authority

IP practice education is considered an effective way to create a collaborative practice-ready workforce which will contribute to AHS’ vision of becoming the best performing publicly funded health system in Canada and the organization’s mission to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans. The possibility of moving IP practice education forward requires the commitment, vision and support of leadership within AHS and its partner organizations.

Funding

Thank you to Alberta Health and Wellness, Health Workforce Action Plan for funding this important work.

This report is appended to one of the deliverables of the AHW HWAP funded project “Building capacity for clinical placements through interprofessional preceptor development and support”

Disclaimer

The results presented in this report do not necessarily reflect the opinions or policies of Alberta Health and Wellness.


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Table of contents Introduction ...................................................................................................................................... C4

I. Partner engagement and communication ............................................................................. C4

1. Partner Engagement ................................................................................................................... C4

2. Communication Strategy ............................................................................................................. C8

II. Preceptor support and education strategies........................................................................ C10

1. Structures and processes to facilitate preceptor role ................................................................ C11

2. Rewards and recognition ........................................................................................................... C12

3. Preceptor education .................................................................................................................. C12

4. Practice and faculty connections ............................................................................................... C15

III. Interprofessional practice education framework .................................................................. C17

IV. Organisational learning strategy ......................................................................................... C19

V. Policies and practice standards .......................................................................................... C20

VI. Use of HSPnet for IP practice education coordination ........................................................ C23

VII. Performance monitoring ..................................................................................................... C24

Conclusion ..................................................................................................................................... C25

References .................................................................................................................................... C27

Appendix I – Glossary .................................................................................................................... C39

Appendix II – Opportunities for partner engagement ...................................................................... C40

Appendix III – Possible risks during partner engagement ............................................................... C41

Appendix IV – Key messages and communication strategies internal to AHS ................................ C42

Appendix V – Key messages and communication strategies external to AHS ................................ C44


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Introduction The complexity of health provider education means that education can no longer be conceived as a system where universities "teach" students how to do things, while health services provide the opportunity for them to "practice" things with real people. This involves recognition that the production of knowledgeable, skilled, and competent graduates is a shared responsibility. Practice education constitutes about 30 to 50 percent of students’ education. Practice education is an umbrella term used to describe all aspects of student clinical placements and is designed to bridge classroom theory and professional practice [45]. During the practice education experience, students are paired with a preceptor, that is, a healthcare provider from the same discipline that helps the student learn the roles in a particular area of practice. The preceptor supervises and evaluates the student [45]. The preceptorship must be viewed as an essential component of high quality health provider education for which universities and health services provide the necessary resources [72].

This paper presents a summary of current issues in interprofessional (IP) practice education and preceptor support in general, with reference to current state of practice education in Alberta Health Services (AHS) where appropriate. Interprofessional refers to situations where two or more health professions jointly create and foster a collaborative learning environment. The goal of these efforts is to develop knowledge, skills and attitudes that result in interprofessional collaborative behaviours and competence [35].

Information was gathered from the published literature, an environmental scan of existing initiatives, research conducted within AHS and discussions with working group members and partner organizations. The issues highlighted concern practice education and preceptors across all health professions although the literature is dominated by references to nursing.

This background paper serves as the foundation for the development of strategies and recommendations for moving towards an organizational approach to high quality IP practice education within AHS.

I. Partner engagement and communication Partner engagement and effective communication with all partners involved are fundamental for successful IP practice education. Although these components are presented separately, they are inextricably linked.

1. Partner engagement Partnership includes two components: engagement of partners and the actual partnership itself. Engagement is a more informal process that involves identifying partners and clarifying the vision for the partnership. Engagement can be defined as “the process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the well-being of those people” [43]. The International Association for Public Participation [91] has identified five levels of engagement: 1) informing partners by providing them with objective information, 2) consulting partners and obtaining their feedback, 3) involving partners throughout the process, ensuring their concerns are understood, 4) collaborating with partners in each aspect, and 5) empowering partners, placing the final decisions in their hands. Despite being seen as more informal, purposeful engagement of partners is required to be successful. The actual partnership is a more formalized agreement where roles, goals and expectations are clarified. The partnership model outlined by Scott and Thurston [146] provides a useful foundation for the description of partnership and partner engagement.


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Identifying and engaging partners

Partner engagement begins with an awareness of a need for the partnership [73,146]. Partners may start out isolated, but eventually encounter each other, initiate communication and collaborate if the partnership meets mutual needs [106]. Organizations need to be ready to commit to the partnership, so the timing of initiating the partnership is important [115]. Engaged partners may identify other potential partners (snowball technique), increasing buy-in to the partnership. It is also important to engage individuals at multiple levels of an organization. For example, Moscato et al. [118] identify three levels of community-university partnerships: 1) Dean and health profession executive, 2) project coordinators and managers, and 3) clinical instructors, clinical faculty coordinator and students. Similarly, MacPhee et al. [108] suggest engaging partners from academia and healthcare organization at the executive and staff levels.

The following partner groups have been identified as being important to engage as part of IP practice education in Alberta and Alberta Health Services (AHS). The list is comprehensive, but may not be exhaustive as different contexts may include different partners.

Internal to AHS

• Senior leadership (EVPs, SVPs, VPs), managers, all staff • Preceptors • Educators • Professional practice leaders • Rural and urban hospitals and health centres (administration and staff) • Community health (home care, public health, and AHS Primary Care Network

staff) • Patients and patient advocacy groups, families • Health Advisory Councils

External to AHS

• Educational institutions (administration, faculty and students) • Regulatory bodies and professional associations • Other non AHS clinical sites (primary care networks (PCNs), non-PCN

physician clinics, community health centres, long-term care facilities, assisted living, community pharmacies, shelters)

• Community (e.g. need to provide safe and affordable housing for students) • Federal, provincial, and municipal governments


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Vision

Workshop participants stated the importance that everyone involved in IP practice education be “on the same page”. Although partners represent different organizations and a variety of professions with varying agendas, the focus of the partnership should be a single shared vision [146]. The draft vision should be shared with the formal partnership group for their review, input and changes. Ideally, partners should be involved in developing the vision as a group to maximize ownership and shared understanding. A single shared vision leads to action and eventually outcomes. Terms of reference can assist in clearly identifying the mandate and work of the partnership. Evaluation is an integral part of ongoing partnerships [146] as it allows partners to monitor and review whether the partnership's aims and objectives are being met [73].

Role clarity

Once the vision is established, it is important that role expectations for each partner are clearly defined in order to achieve the vision [34,73,74,82,115]. Role expectations can be clarified in small group discussions where partners identify their strengths and what they offer the partnership. This further facilitates engagement and commitment [106]. Formal documents that clearly define the roles and responsibilities of key groups or institutions in the partnership (e.g. student, preceptor, faculty) [153] or a health authority and educational institution [84] are essential. This can include expected competencies for preceptors, mentors and educators [178].

Common definitions are also important to ensure all partners have a common, agreed upon understanding of the terms [146]. A glossary of terms (Appendix I) has been created to facilitate a common language for partners involved in IP practice education. These definitions should be validated by partners.

Commitment

Building sustained commitment from all partners is the key to successful IP practice education. This can be facilitated by encouraging active participation in decision making, providing input into education strategies, health services delivery and other healthcare activities, along with sharing ideas, resources and skills [106]. It is important to have commitment to the partnership at both the individual and organizational levels, as the partnership will not be effective if an individual is committed, but their organization is not or vice versa. It is also important to recognize that partner engagement is an ongoing process. With open and effective communication [17,34,61,74] partners will develop and maintain trust in each other and the partnership overall [102,106,107,115].

There will always be some fluidity in commitment to a partnership. For example, individuals may leave the partnership due to a change in their position or perhaps the partnership no longer aligns with their needs. If the partnership continues to be viable and there is outstanding work to be completed, these partners should be replaced. If a formal partnership agreement is in place, a process for replacement and substitution of individuals may be addressed within that document. Individual level changes may or may not have a significant impact on an established partnership.

Leadership

Leadership in a partnership is important to implementation of the vision, ensuring work moves forward and for the sustainability of the partnership. Leaders should model openness and provide support and personal advocacy, leading partners toward organizational change [82]. Often, leadership in partnerships is provided by a champion [83] or a passionate leader at the local organization level [82]. In the initial stages of partnership


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formation, partners rely on a leader to provide direction [174]. As the complexity of the systems involved in the partnership increases, leadership should rely more on empowerment, facilitation, self-organizing structures, participatory action and continuous evaluation [82]. Co-leadership may also be considered to share the workload, foster equity in the partnership and reduce the likelihood of one organization dominating the partnership. Co-leadership builds capacity and enables smoother transitions if leadership changes.

Impact of context

Many different factors, internally and externally, can impact a partnership. Internal factors can include intra-group communication and leadership. In the beginning stages of the partnership, there is a greater reliance on the leader to set the vision for the partnership [82,165,174]; there may be a testing as partners get a feel for what behaviours are acceptable in the partnership [165]. As the partnership develops, communication becomes more open [174]. Partnerships that develop at a slower rate over time are likely to be more personal with greater emotionality [165]. Conflict between partners is inevitable, but this will result in trust when partners realize they are free to disagree with each other [165,174]. As the partners learn to relate to one another and resolve conflicts, they eventually move into the goal achievement and task accomplishment phase [164,174].

External factors are of particular concern where there is a broad range of partnering organizations and the partnership spans a large geographical area. The group should spend time identifying and acknowledging the impact of external factors such as social, political and economic influences [146]. Examples of these external factors could include reorganization of the partner organizations or fewer representatives from rural and remote areas as compared to urban areas.

Partnership challenges

Collaboration and effectiveness of the partnership are threatened by professional territorialism or unequal power relations among health professionals [17,19]. For example, practice (clinical or health services) and academic partners do not always recognize each others’ expertise [108]. Other factors impeding collaborative IP practice education partnerships include the lack of standardization of processes and preparation of partners, such as preceptors [61]. Although standardization may not always be possible due to different organizational policies and procedures, some degree of standardization is important. In some cases, there may be an imbalance between perceived and actual needs [106], such as information needs or preferred communication methods, or insufficient consultation and planning with partners [106].

Collaboratively identifying barriers to creating working relationships is essential for the partnership to be effective and move forward. Open and respectful exchange of ideas across professional boundaries will result in mutual learning and benefit all partners involved [108,132]. Interprofessional collaboration means each partner represents a different domain, which is an opportunity for organizations to build on the knowledge, experience and skills that each partner offers [153]. Connecting the theoretical and research expertise with real-life wisdom and expertise in community and practice (clinical or health services) settings will result in expanded skills and knowledge and hopefully increased commitment of partners [115].

Resources required

Organizational structure, resources, and communication are needed to move from an informal to formal partnership. Resources that will be required for the partnership include the following:

• Meeting space

• Teleconferencing/video conferencing


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• In-kind time for staff participation from various partner organizations

• Meeting expenses (e.g. travel)

• Printing of materials

• A single contact person to keep the partnership organized and on track See Appendices II and III for opportunities for partner engagement and possible risks during partner engagement

2. Communication strategy The successful implementation of IP practice education requires collaboration of numerous partners and a communication strategy with clear key messages that will facilitate the engagement of partners and other stakeholder groups. This proposed communication strategy was developed in consultation with our working group partners, the literature and an Alberta Health Services’ communications template [2].

A comprehensive communication strategy [2,113,146]:

• Includes clear, concise and consistent messages to facilitate a common understanding amongst all stakeholders

• Defines all terms and avoids acronyms

• Writes messages in plain language to be inclusive of a wide range of target audiences

• Tailors messages for specific audiences, if required

• Enhances the visibility and reputation of a program

• Considers both formal and informal communication mechanisms

• Communicates a clear vision and goals for the initiative

• Provides a short summary and rationale for the initiative

• Outlines roles and responsibilities for different partners

• Communicates the actions required by different groups

• Provides an opportunity for individuals from various groups to obtain more information and/or provide feedback on the initiative

• Includes a more detailed information package targeted to various target groups.

Targeting messages to different groups

The various partners associated with IP practice education will have different information needs. A brief needs assessment is recommended and could be undertaken by talking with one or two individuals in each of the target groups to better understand their informational needs and how they would like to receive information. For example, physicians’ are not fully engaged in IP practice education. This may be, in part, due to a lack of empirical rigor and proof for IP collaborative practice [17]. Taking this into consideration, messages directed to physicians may be more effective if they focus on evidence and outcomes of the program. Support staff are one of the most important links especially to internal communication [171]. Generational differences [106,143], time, and access to a technology will also influence information provided and the means of delivering the message. The importance of targeting messages to different groups cannot be under estimated. On the other hand, fragmentation of messaging across target groups is a risk. A balance is needed between targeted messaging


August 2011 C9

and common themes across messages for all target groups [157]. Messages should focus on issues and policy [115]. Transparency in key messages is important as is the opportunity for partners to respond and provide ongoing feedback [34,61,106,108,115,171].

Development and coordination

The development of a communication strategy is often best done by a small working group of individuals representing various partners in the initiative. In working groups examined by Wheelan et al. [174], groups ranged in size from 2 to 19 members, with an average group size of 7.2 members. Members of larger groups perceived their group to be less productive and as having more characteristics associated with earlier stages of group development (dependency on the leader and conflict) and less characteristics associated with the later stage (goal achievement and task accomplishment). Furthermore, larger groups made more counter pairing statements that indicate avoidance of intimacy and connection, keeping discussion intellectual and formal [174]. Small groups facilitate the exploration of different needs of individuals, groups and organizations.

A single individual should be accountable for the coordination of further development and implementation of the communication strategy. Communication with multiple levels of numerous organizations [115,153] increases the complexity of the work and requires a dedicated individual to ensure communication activities are carried out.

Some literature suggests that a clinical placement coordinator could facilitate activities, streamlining communication of expectations and information among students, faculty, preceptors and administrators [34,74]. This would be especially useful for communication occurring across multiple organizational levels. The coordinator could assist communication between faculty and preceptor before a student begins their clinical placement [34] as is currently being implemented by many clinical placement coordinators.

Communication media

There are many formal and informal communication media including written, verbal and electronic interactions [113,146]. A one-page fact sheet can be effective at summarizing key messages. A briefing note, news release, backgrounder, technical briefing, Alberta Health Services internal (Insite) or external websites, telehealth for staff, Health Advisory Council email, senior leadership email, all staff email, Interchange e-bulletin, story or info sheet and Leadership Matters (e-bulletin) are other options suggested in the AHS Communications template [2]. There has also been a recent move towards

engaging AHS employees, the public and other stakeholder groups using social media tools such as Twitter, Apple Magazine on Facebook and YouTube [3]. AHS is currently in the process of developing a policy for acceptable social media use. Both electronic and paper-based communication options should be considered.

For communication around IP practice education, web-enabled databases and tools have been shown to improve communication among education and practice partners, allowing for electronic placement requests, online course and student profiles and up-to-date site information [84]. In Alberta, not all clinical sites can access HSPnet Alberta [84], nor are all healthcare occupational groups using the database.

A one-page fact sheet can be effective at summarizing key

messages.


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Opportunities and risks

Significant opportunity exists in the IP practice education initiative to communicate information about the project and other key messages to a wide range of stakeholders. Risks related to the communication strategy include the lack of clear messages, misunderstanding the information, inappropriate timing of communication activities and not reaching the right individuals or groups. All these risks need to be carefully considered in the development and implementation of the communication strategy. Evaluation of the communication strategy should be ongoing to understand its effectiveness and evolution [113,146]. For example, the impact of the communication strategy could be evaluated to determine whether it is portraying the intended messages to the appropriate audiences. Evaluation could also demonstrate whether the communication strategy is sustainable.

Communicating messages about IP practice education will result in greater awareness for both internal and external audiences. Important information about policies, structures and processes will be helpful to all stakeholder groups. Messages may be interpreted differently dependent on the audience, along with their willingness to embrace the initiative. Greater education and awareness can also result in further engagement by partners within or outside AHS and has the potential to increase the number of partnerships.

Resources required

Resources will be required to support an individual responsible for the further development and implementation of the communication strategy. This may include administrative support, time and travel. Development costs, cost of materials and cost of distribution (e.g. mailing costs, time to send e-mails) will also need to be considered.

Supporting documents

The communication package, which should be short and in plain language to increase understanding and buy-in, should include supporting documents such as:

• Glossary of terms

• Backgrounder

• IP competencies document

• Competency documents for nurses and allied healthcare professionals

See Appendices IV and V for key messages and communication strategies internal and external to AHS.

II. Preceptor support and education strategies When preceptors are well-prepared and supported in their role, they report higher confidence in their skills [27,51,60,70,75-77,124,130,142,148,155,159,167], greater job satisfaction [11,51,60,75,76,77,124,130,148] and increased satisfaction precepting [60,124]. Of special note, preceptors who had ongoing support reported positive perceptions of the role regardless of the number of students they preceptored whereas preceptors who did not have continued support reported decreased perception with higher numbers of preceptees [90]. Preceptors that feel well supported report greater intent to remain in the unit, facility or organization [130]. Well-prepared preceptors’ students report a more satisfactory student placement experience including more accessible preceptors who are more interested in them both professionally and personally [129], improved learning (e.g. critical thinking skills) [11,124,130], professional role modeling [148] and greater independence [129]. They declare intent to pursue employment opportunities within the unit, facility or organization of their student placement [45,130] and are more likely to engage in future preceptor roles [112].


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Benefits to the organization include staff recruitment and retention, better prepared students [124] and a more positive culture within the workplace [149].

1. Structures and processes to facilitate preceptor role The literature reported several structures and processes to facilitate the preceptor role including: Workforce adjustment and colleague support, Formalized goals and expectations, and Networking opportunities.

Workforce adjustment and colleague support

Workforce adjustment and the support of their colleagues and supervisors assists preceptors to provide students with a positive placement experience, lessens the preceptors workload and reduces stress for the preceptor, student and others taking an active or supportive role in the preceptorship.

Ensuring preceptors have protected autonomous time to orient their student, provide feedback and complete required documentation [45,57,60,72,75-78,81,133,137,140,176,179] is critical for preceptors. This might require a change in work arrangements such as relief time from the daily patient case load. Having sufficient offline time for preceptors to facilitate debriefing, reflection and completion of education-oriented documentation [81] increases the likelihood of positive preceptor and student experiences. Colleagues can support preceptors by actively engaging in precepting or mentoring students [32,57].

Formalized goals and expectations

Managers have an important role in ensuring written agreements or contracts are in place explicitly stating goals of the placement, clarifying the roles and responsibilities of faculty, preceptor, student and organization. These agreements help all participating partners come to a shared understanding of respective roles and responsibilities and promote a positive experience for all preceptorship participants [36, 39, 48, 57, 70, 72, 97, 137, 147, 179]. These agreements should also set the expectations about the preceptor-student relationship including the student’s ability to identify their own learning objectives, frequency of interaction, and student motivation and preparedness for clinical setting. Well prepared students contribute to the recruitment and retention of preceptors [39] by decreasing stress on preceptors resulting in willingness to precept [97]. Collaboration around expectations and goals facilitates successful student placements and satisfactory preceptor experiences and there is minimal risk associated with setting expectations [147].

Preceptors are sometimes challenged when assessing or evaluating students. Clarity about preceptor's responsibility in evaluating students [75-77], appropriate student evaluation tools and training or guidance in the evaluation process [57,70,72,97] would support preceptors.

Networking opportunities

Preceptors expressed the need to have a mechanism by which they could discuss problems in their mentoring relationships and get advice [133]. Mentors felt abandoned by the system once they assumed leadership positions within their institutions. Formal and informal networking opportunities and resources to facilitate relationships with other preceptors support ongoing education and orientation of preceptors. This may include creating space for preceptors to network outside their work site, relational databases that helps them to connect to other preceptors, or mixer lunches or dinners that allow preceptors to share experiences with others [36,57,93,133,137,140,176]. Online discussion boards or Wiki sites can be useful for networking and ongoing learning or sharing opportunities, especially since they provide flexibility and are accessible to urban, rural and remote participants. They may pose challenges, such as access to technology or the ability to establish and / or maintain relationships with colleagues online [173].


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2. Rewards and recognition Preceptors often voice frustration about the lack of recognition from the organization for the extra duties they perform. Hyrkas & Shoemaker [90] report a positive and statistically significant correlation between preceptors’ perceptions of benefits and rewards and their commitment to the preceptor role. Rewards and recognition acknowledge the preceptor’s efforts and are intended to show appreciation and respect for those who take on the role of preceptor. The literature reports two broad categories of extrinsic rewards: remunerative and non-monetary.

Remunerative rewards may be in the form of salary or special funding. Studies suggest rewarding preceptors by direct financial means such as provision for additional salary [45,57,72,78,90,140,147,179] or financial compensation to facilitate preceptor educational opportunities or networking such as attending conferences or continuing education [39,72,75-77,133,147]. The fiscal constraints under which many Canadian healthcare organizations operate challenges the feasibility of these financial rewards [179].

Non-monetary rewards and recognitions fall into two broad categories – career opportunities and advancement, and awards. Career opportunities and advancement include recognition of precepting during employment performance reviews or as a criteria for promotion, appointment to adjunct faculty position, opportunity to participate in research or serve on an advisory board, continuing education or professional development event, audit graduate classes, library privileges or journal subscriptions [39, 45, 53, 57, 72, 75-77, 81, 90, 93, 97, 133, 140, 147, 158, 179]. Awards include items such as letters, certificates or notes of thanks, recognition or commendation, an appreciation day or meal, or promotional items such as jackets, shirts, pens, mugs, pins [39, 45, 53, 72, 75-77, 90, 93, 133, 137, 140, 147, 158, 176, 179]. Preceptors rank continuing education opportunities highest, followed by auditing graduate classes, an appreciation meal, letter of commendation and adjunct faculty appointment [158]. Using existing resources (e.g. library access, continuing education credits, certificates) would be cost effective [179].

Whatever type of reward or recognition is used, studies recommend varying reward and benefit strategies dependent upon preceptor's workplace, graduation year, discipline, level of education and age [45,90]. Ideally, rewards are individualized so they are perceived as personally or professionally meaningful [75-77,90]. It is also very important that organizations facilitate recognition of preceptors [32] and advocate for faculty support of preceptors [32].

3. Preceptor education Providing preceptors with education and orientation is the most commonly reported support mechanism. Ensuring preceptors receive adequate orientation, education, and opportunities and resources for ongoing or refresher learning [27,30,32,36,48,49,57,60,63,67,70,72,75,76,77,78,81,90,93,96,97,117,133,137,140,147,172,176,179] in a format preferred by the preceptors [75-77] facilitates confidence and prepares them to take on the responsibility of precepting a student.

There are numerous education strategies currently being used. Generally, education can be classified as formal education, non-formal (or further) education or informal learning. Formal education is learning which occurs through a program with instruction and evaluation often recognized for qualification or certificationa [66,69,104-105]. Non-formal (or further) education constitutes organized, short-term learning that usually does not lead to qualification or certification [69,104-105]. Informal learning is generally voluntary, and usually associated with work or leisure activities [66,69,104-105].

Both non-formal (or further) education and informal learning have been found to be important factors in orienting individuals to their roles [11,57,59,162]. Non-formal education can be classified into three main


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categories: independent studies (e.g. online modules, print material), face-to-face sessions (e.g. workshops) or blended learning opportunities (e.g. combination of independent and face-to-face). Informal learning is a more casual way of both learning and sharing lessons learned with colleagues and others. These activities include reading, engaging in workplace mentoring and discussions with friends or colleagues [69,145,150]. Organizational learning strategies should include action plans for both non-formal education and informal learning.

Some literature recommends aligning the education delivery method to learners preferred learning style. While the majority of literature regarding preferred learning styles focuses on students, the findings can also be applied to the education of preceptors. Factors such as generational differences [9,52,156] or perceptual modality preferences (e.g. visual vs. auditory) [44] may affect the user’s optimal learning experience. However, the use of learning styles must be balanced with material content and learning context [101,154,169] and care must be taken not to make generalizations based solely on generational differences [68] or preferred learning styles.

The following section will focus on the methods that can be used to deliver education to preceptors and discuss the advantages, disadvantages, implementation and required resources.

Electronic or web-assisted learning

Electronic or web-assisted learning is generally either non-interactive or interactive. Adult learning principles indicate that interactive learning is more effective and efficient than non-interactive.

Non-interactive

Non-interactive electronic or web-assisted learning is material delivered in a static electronic environment such as on websites or CDs/DVDs. The material can be on the webpage only (e.g. html) or be available in printable formats.

Interactive

Web-assisted learning can also be interactive and actively engage the learner. There are a number of ways in which this can be accomplished. Webinars which are presentations delivered online, in real time, usually allow a dialogue (e.g. audio, text) amongst the presenter and the session participants. This greatly increases the learning aspect since participants can ask questions or make comments on the material thus increasing the interchange and learning opportunities.

Interactive, self-directed online scenarios provide feedback on learner’s response to a scenario at decision making points or action points and an overall critique of the learner’s scenario outcome. This education delivery format can be optimized to provide a dynamic environment that requires learners to apply a cognitive process to evaluate the scenario and action options, apply the content to solve the problem and achieve a meaningful end, and receive feedback on the learner’s decisions and scenario outcome. This method can be used not only to teach specific skills but is ideal for the other knowledge requirements (e.g. critical thinking skills, decision-making, providing feedback) and provides learning opportunity to make on-the-fly decisions that must also align with prescribed standards and practices [116].

There are several advantages to web-assisted learning, both non-interactive and interactive. It allows self-directed learning and is flexible (e.g. accessible at times and in places convenient to the learner including rural and remote areas) [36,47,57,123,124,130,135,141,164], is economic (e.g. minimal travel requirements,


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multiple site availability with minimal increased costs to the organization) [123,141], and consistent (e.g. no variability in material/message or its delivery) [130,135,164]. If the material is posted to a website (rather than distributed via CD or DVD), there are additional advantages such as ease of keeping material current by updating the online material and the opportunity to include links to other online resources [60,110] thus expanding the breadth and depth of information available to learners.

Disadvantages of both interactive and non-interactive electronic or web-assisted learning include a high dropout rate [54,62,166,175], challenges with technology (e.g. equipment requirements, learners / users level of comfort with computers, internet access) [47,130,141], cost of equipment and IT support, availability of equipment and IT support [130,141], assumption that people are capable and comfortable with self-directed learning, and lack of personal interaction [130]. Strategies to mitigate attrition include development of a culture that takes online learning as seriously as classroom training, holding managers accountable for the success of their employees, using managers as role models, creating a social dimension to e-learning, making expectations clear, providing formal rewards, and tracking performance [54,62,166,175]. To mitigate challenges related to equipment requirements, communication and collaboration amongst the content developers, curriculum designer and information technology is essential. Easily accessible help with using the online medium assists users with limited familiarity with electronic learning platforms. To help online learners be successful with self-directed learning and the lack of personal interaction, a blended approach to education may be the solution. This is discussed in more detail below.

Required resources or requirements for electronic or web-assisted learning include equipment and technical support. Implementing this education delivery method may be challenged in rural or remote areas if the focus is on web-assisted learning as internet accessibility in these areas may be limited or not available.

Face-to-face learning

Face-to-face learning includes such education delivery methods as workshops, seminars, coaching and simulations. There are numerous advantages to providing learning opportunities with face-to-face encounters. Primarily it allows learners to interact with the instructor, trainer and other learners [10,46]. For some learners, these group dynamics, sense of community, and synergy to exchange ideas and learnings is more easily facilitated in these face-to-face sessions than through real-time, interactive web-assisted methods [10,12,16,22,31,127,129]. The primary disadvantages with in person training are cost (e.g. travel, attendee’s time away) [27,112,145] and time commitment [27,67,75-77]. In some cases, learning can be optimized by multiple sessions with an opportunity to gain experience between sessions and allowing reflection on those experiences [46]. Resources required include support and endorsement of organization leaders, including evaluation and communication [27] and funding to backfill attendee’s time [75-77].

Coaching has the added advantage of individualized focus on the learners’ needs and being more consistent with teaching or helping others to learn [27]. Using a train-the-trainer strategy not only teaches individuals to be preceptors but also provides them with the tools and skills to teach others how to precept, thus promoting sustainability of trained preceptors through cascading education [49]. Group mentoring or co-mentoring (e.g. two or more mentors simultaneously provide guidance and knowledge to two or more mentees) has been shown to enhance the preceptor experience and diversity of group members’ experiences and interests supports group dynamics [10].

Simulated learning sessions make use of role playing with the added advantage of providing a safe environment since the “patient” is often a mannequin rather than a live person [28,71,177]. It allows the trainer to control the environment thus optimizing the learning experience [28]. In addition to clinical training or


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learning, simulation can be used to teach teamwork competencies through modeling or simulating knowledge, skills and attitudes. Simulated situations are also an opportunity for an interprofessional team to practice standardized tools and behaviors, appropriate assertion, and critical language to greatly enhance safety by bridging the differences in communication styles [103]. Post-simulation debriefings are used to reinforce the lessons learned during training [28,59,136]. Simulation is currently being expanded within Alberta Health Services and discussions are ongoing about the applicability of simulation for the purposes of non-clinical specific skills such as decision making, learning critical thinking skills, or giving and receiving feedback [98] and communication [170]. Costs associated with simulations include the mannequins (e.g. acquisition, maintenance) [28], computer equipment and software, time to train the session facilitators, and time for preceptors to attend sessions. A lack of reality or feeling of contrivance was reported by some users of the simulated environments [170].

Preceptors report advantages of in person learning including enhanced self-esteem and confidence in skills [27,51,70,75-77,142,148,155,159], improved relationships with other preceptors [27,142,155], and an opportunity to share experiences and learnings [22,27,142].

Print (or books on tape)

Manuals and books are still quite popular though becoming less so. The advantage of this type of learning delivery is flexibility since learners can access the medium wherever and whenever they choose (e.g. riding public transit). The environmental scan revealed a number of well-regarded print materials (e.g. [40,56]). The major disadvantages include material becoming dated, cost, a greater time and effort commitment, and a lack of interactive opportunities.

Blended methods

Using a combination or blended method of delivering education is generally considered best practice [33]. Examples of this include providing basic information via web based medium followed by in person sessions which reinforce and expand the basic material. Or, in person sessions are used to introduce material, followed by web based information and another in person or interactive web based learning or support session [33,45,62,112]. This delivery method has been found to optimize different learners’ preferences and minimize disadvantaging any one group [62]. Students also reported more satisfactory experiences with preceptors who were provided with opportunities to be exposed to blended education delivery methods [45,112].

The combination of web-assisted and in person learning provides flexibility and allows the advantages of group work or role playing which are more difficult to provide with web-assisted education methods alone. Preceptors provided with the opportunity to access a combination of learning methods reported being highly satisfied and believed the combination of electronic and in person learning reinforced the initial learning and the lessons learned [33]. Students of these preceptors reported positive experiences with the organization and with the learning experience. The cost of the required resources to provide blended education opportunities may be an organizational barrier.

4. Practice and faculty connections A critical piece in examining the role of preceptors in the organization is the relationships between preceptors and the educational institutions. More broadly than the connections between preceptors and educational institutions, the linkages between AHS and educational institutions in general should be considered. The design of IP practice education is not always conducive to students learning their role as health professionals or preparing them for collaborative practice. There is often a disconnect between the stated objectives of the


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educational institutions and approaches of the people responsible for educating their students in clinical settings [29].

This section will discuss themes that have arisen in research and in experiences of key stakeholders in practice education. We will review the key issues in the practice education interface and provide suggestions to improve alignment between practice and academia around IP practice education.

Role of the preceptor

A significant amount of learning about a particular health profession (e.g. nursing) occurs in practice environments [134]. As a result, preceptors and clinical instructors play a critical role in students’ clinical education; they are at the nexus of education and practice. Preceptors receive a variable amount of guidance from AHS or the educational institution on how to provide positive and effective learning experiences for students.

Clinical instructors and preceptors may not share the same understanding around concepts like collaboration or scope of practice as the faculty from the educational institutions. For instance, faculty can speak to the importance of learning collaboration, of learning through observation and reflection, but preceptors may not share this understanding [29]. Furthermore, preceptors and faculty are not necessarily aware of one another’s expertise and do not always share resources effectively [108].

When students are in the practice setting, they are focused on practicing clinical tasks. Faculty members speak to the importance of learning role and collaboration rather than completing set numbers of specific tasks but this may not be filtered down to clinical instructors and preceptors. The pressure that students experience around completing tasks, such as starting IVs or measuring shoulder range of motion, may limit their opportunity to also focus on learning the less procedural skills like communication and collaboration [29]. Educational institutions may need to review their student performance documents to ensure a range of skills, not just clinical ones, are included to help make all these skills part of the placement experience.

Collaborative practice

Educational institutions increasingly emphasize the importance of interprofessional education to foster collaborative practice. Collaborative practice is taught to students in the classroom and students often speak to the importance of the concept. However, the clinical environment is not always conducive for students to gain experience in collaborative practice [29]. Students may have little opportunity to see collaborative practice take place or participate in it during their clinical placements. Students’ interactions with members of other professions are either unplanned or at the discretion of the students’ clinical instructors or preceptors [29]. Little emphasis is placed on learning how to be part of the team or understanding the roles of other professions.

Also, the educational requirements of practice education do not explicitly focus on collaboration. Since learners value what is evaluated, it is critical that learner assessment include specific metrics around collaborative practice. Sometimes, the collaborative practice competencies such as communication, collaboration, role clarification and reflection are not sufficiently highlighted.

The educational requirement for some disciplines (e.g. nursing requires students research their patients before a shift and provide total patient care to only those patients) may impede them from collaborating with staff and other students as learning opportunities arise [29]. Depending on the level of student and the objectives of the practice experience, the focus on providing care for only one patient may also limit opportunities for students to


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reflect on their provider role (such as understanding their role as more than knowledge of clinical tasks specific to a setting).

At the practice site

Educational institutions and practice settings in which students are placed may have different organizational goals; however, if well-functioning relationships betweens these groups are established, it is possible to develop sustainable programs that meet both education and service delivery goals simultaneously [99]. Greater collaboration between post-secondary institutions and healthcare organizations is associated with a variety of positive outcomes, such as decreased orientation time needs for students and faculty, more involvement with clinical support services and care management, and more informed employment choices by senior students [125].

As the primary provider of health services in Alberta, AHS is a major partner of post-secondary institutions seeking practice placements for students. AHS has a responsibility to provide positive placements for students. As numbers of students increase, increasing the number of students in clinical settings at the same time is critical. Increasing the number of students in a service area at the same time is difficult due to lack of space and staff resources.

Processes on staff supervision of students are at the discretion of the service area or of the individual health provider. Service areas have wide variability on how they incorporate students and instructors into their environments. Staff have widely varying degrees of competency in working with students. This applies not only to preceptors, but to any staff who interact with students. Not all staff members feel comfortable working with students and some do not view working with students as part of their jobs. A major source of stress for staff is that they do not understand the scope of practice for the level of students placed with them. Staff members may not know which of their colleagues are clinical instructors [29]. Burnout among nursing staff who preceptor students is very common [172].

Students are often uncomfortable introducing themselves to staff or telling staff their learning objectives and the activities they are competent to complete. Students often feel uncomfortable asking staff for help. At times students may feel they have nothing to do, for example, if their patients are away from the unit or they have completed all patient related work and they cannot find or are not aware of other learning activities. From the other side, staff members at the practice site do not consistently interact with students or invite them to participate with staff members [29 ].

Applied research suggests it is possible to maximize the number of student placements while simultaneously ensuring a quality learning experience and improving practice readiness. Documented attributes of models that have achieved this include leadership and commitment to collaboration from all key stakeholders; a philosophy of learning community and facilitation of interprofessional education opportunities; a common, supported and rewarded preceptorship program; dedicated clinical facilitators; greater use of different shifts and weekends for placements; a shared clinical calendar and expanded number of placement weeks; common clinical objectives, skills set and student evaluation tools; and regular face-to-face communication between key stakeholders [18].

III. Interprofessional practice education framework Currently, practice education is inconsistently managed throughout AHS. When the nine former Alberta health regions, Alberta Cancer Board and the Alberta Alcohol and Drug Abuse Commission (AADAC) were merged, each organization brought a different approach and processes to manage student practicum placements. Recently Emergency Medical Services and the health facilities from Correction Services have joined the AHS


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organization, again, each with its own approach to practice education. This inconsistency results in inefficiencies within AHS and confusion for both internal and external stakeholders around the student placement process.

In addition, enrolment has increased in educational healthcare programs throughout Alberta and there is a clear expectation by the educational institutions that all their placement requests must and will be met by AHS facilities and programs. The education program expansion has led to an annual increase in demand for practice education experiences. At the same time, a number of restructuring activities within AHS have had an effect on AHS facilities and programs, which will severely challenge the organization’s ability to meet this increased demand for student practicum placements.

The development and implementation of an IP practice education framework would

• Inform a sustainable, coordinated, systematic approach to IP practice education in AHS

• Facilitate the development and implementation of strategies to expand AHS’s capacity

• Improve planning and decision making

• Focus on improving the quality of student practice education opportunities provided in AHS

• Build on prior Alberta initiatives

There are a number of initiatives already in place in Alberta that aim to implement IP practice education approaches. One example are the interprofessional clinical learning units (IPCLU), in three different patient care contexts, which aim to: enhance an IP teaching and learning culture, increase awareness surrounding IP teamwork and roles, promote IP communication and decision-making strategies, and further develop clinical reflection [152]. The IPCLU project goals are: enhance patient-centred care, increase opportunities for IP patient care team members, faculty and healthcare students to learn and practice together, support and develop existing IP learning and practice, and improve the transition of health sciences students into the IP team [21]. To accomplish this, an IPCLU is a collaborative model of clinical teaching and learning developed on an existing patient care unit, incorporates strategies that steadily build the capacity of both experienced and newer faculty and patient care team members, contributes to the clinical education of students and the patient care team, and strives to create a positive interprofessional practice environment for students, faculty and patient care team members [126]. A number of tools were used on the IPCLUs to promote IP practice education including an IP resource centre and learning room, IPCLU board listing IP educational opportunities, IP orientation and communication, acknowledgement of team membership and roles, shadowing guidelines, feedback and documentation of the student’s IP growth and evaluation of IP competencies [21,41,65,127]. Several of the tools were designed to communicate to staff, patients and their families such as a patient bedside board that listed all the staff assigned to the patient, patient scheduling boards located near the unit desk which made it easy for staff, patients and their families to know the patients schedule for the day, the doctors and their round days/times.

A Health Canada funded project explored the feasibility of implementing an IP mentoring approach into practice education [50,100,160]. IP mentoring is an educational strategy that promotes student mentoring in clinical placements by members from different health disciplines including staff and students. Marshall and Gordon [111] explain that the purpose of IP mentorship is not to inculcate students into different professions, rather it should be “about professions learning from and about each other to improve collaboration and quality of care” (p.40). These mentoring experiences supplement formal preceptorship/clinical supervision. For example, a nursing student in a clinical practicum is mentored, supervised and evaluated by her nurse preceptor. In addition, this student has mentoring relationships with other healthcare providers (e.g. occupational therapists,


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social workers, physicians) and other students in her placement. IP mentors are not intended to replace the assigned preceptor; rather they supplement, support and enhance the supervisory role of the student’s principal preceptor. IP mentorship promotes collaboration and shared learning among staff and students. All teams members have the opportunity and responsibility to learn from and teach each other [131]. Responsibilities for mentoring are shared by the group and novice providers may serve as mentors for each other [131].

IV. Organisational learning strategy The purpose of an AHS learning strategy is to support continuous, consistent and cost effective learning opportunities for AHS employees. This aligns with Transformational Improvement Program #4 (TIP#4): Enabling our people to achieve excellence in providing health services [4]. The development of a learning and development strategy is one of the ways AHS will achieve TIP#4 goals including staff who are supported by education, incentives, tools and information, and a workforce that is future-ready with the qualifications, skills, attributes and experience required to provide excellence today and tomorrow.

Current state of the learning strategy in AHS A search of AHS intranet failed to yield an organizational learning strategy. However, this strategy is listed as a deliverable in several documents including the AHS Human Resources Strategy, AHS Workforce Engagement Plan and subsequent updates, and the Learning and Development Policy EAR-09 (LDP). The LDP provides a comprehensive basis on which to build the learning strategy by clearly articulating that AHS is committed to promoting excellence in the delivery of quality health services by supporting formal and informal learning and professional development of its employees. To further illustrate its commitment to learning, a recent proposal would include learning as a core AHS value.

Components of a learning strategy Stakeholders who participated at an AHS hosted November 2010 workshop to validate an early draft of the concept design identified the organizational learning strategy as a key component to support IP practice education and preceptor development, and suggested the strategy focus on the following elements:

• Learning strategy that values relationships as a core principle and builds on adult learning principles

• Support all preceptors within AHS, regardless of discipline

• Develop modules not just for preceptors but for all employees to support their contribution to promoting IP practice education

• Start with students now as they are the preceptors of tomorrow

• Integrate “old” concepts such as family-centred care

• Focus on role clarification (e.g. know when and to whom to refer)

• Consider preceptor certification associated with a 3-4 month preceptor program

While an AHS organizational learning strategy does not appear to be available, some aspects of such a strategy are being implemented throughout AHS. Examples include MyLearningLink which provides AHS staff with a single point of access for AHS learning opportunities and saves users learning information such as completed courses, certificates earned and courses for which the user is registered. Another initiative is a learning inventory to inform the future direction of the learning strategy. The inventory was collected via an online survey during June and July 2011. The findings will determine what is currently available and what is missing in order to focus AHS resources on providing high quality, high impact learning and development opportunities to create a sustainable learning and sharing culture. AHS managers have access to LEADS


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which assists them to identify competency gaps and learning opportunities and guide the managers in how they recruit, select, develop, assess performance, plan for succession and recognize leaders among their staff.

Strategies outside AHS These suggestions are in alignment with strategies identified in other jurisdictions most notably British Columbia. In addition to the suggestions listed above, a focused literature review identified the following steps to develop a strategic plan [24].

1. Undertake a province-wide survey on the state of practice placements for healthcare providers

2. Conduct a summit of stakeholders and partners from health and education sectors to examine survey results and make recommendations for improving IP practice education

3. Dedicate funding for projects to address one or more of the summit recommendations

4. Evaluate projects and have stakeholders and partners examine the findings to recommend next steps

5. Develop an IP practice education strategic plan

6. Form working groups and forums, with dedicated funding, to address IP practice education issues on an ongoing basis

V. Policies and practice standards AHS policies have organization-wide application and help ensure compliance, mitigate organizational risk, and provide a framework for planning, action and decision making. The purpose of a policy is to set a clear, predetermined, and predictable course of action for the organization. Policies are enacted through the application of procedures, which provide the information necessary for individuals to fulfill the intent articulated in AHS policies [5].

Current AHS landscape for student placements and IP practice education policies and standards

The current status of AHS policies and standards regarding IP practice education and student placements are in flux due to a major organizational merger1 and ongoing reorganization and realignment within the merged organization. During the time of transition, former health entities (also known as legacy) policies are in effect [6].2

Several sources were accessed to determine the current state of student placements and IP practice education policies and standards – internal and external AHS websites, internal and external legacy websites, and AHS employees involved with the development of student placement policies and standards.

1 On May 15, 2008, there was a major organisational change to Alberta’s healthcare system. A single provincial entity, Alberta Health Services (AHS), was created and tasked with coordinating the delivery of health services. Effective April 1, 2009, all former health entities (Calgary Health Region, Northern Lights Health Region, Chinook Health Region, Palliser Health Region, David Thompson Health Region, East Central Health Region, Capital Health Region, Aspen Health Region, Peace Country Health Region, Alberta Mental Health Board, Alberta Alcohol and Drug Abuse Commission, and Alberta Cancer Board) were dissolved and amalgamated under AHS. 2 Corporate policies and procedures at the 12 former health entities, departments, or facilities remain in effect until September 2010 or until they are replaced by an equivalent AHS document.


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Draft AHS Student Placement Policy (Under consideration) A draft AHS Student Placement Policy3

AHS external (public) website

has been developed and is awaiting final endorsement prior to adoption. The draft policy acknowledges AHS as a teaching and learning organization that supports and encourages the participation of students in clinical, corporate, technical or administrative placements. It stipulates the primary responsibility for patient care remains with AHS staff members responsible for the patient. Instructors from educational institutes who provide direct care to a patient within the context of teaching students must only do so within their competency of practice. Further stipulations of the draft policy include requirement of a Student Placement Agreement (SPA), retention of the SPA and student placement information, and documentation of patient care on the health record. The draft policy also specifies student placement eligibility, student placement approvals and student placement requirements. The draft policy contains definitions for several terms (e.g. department, educational institution, instructor, preceptor, student, student placement). A number of reference documents are listed including various AHS policies and procedures (e.g. Access to information, Recruitment and employment practices), Freedom of Information and Protection of Privacy Act, Health Disciplines Act, Health Professions Act, Physiotherapy Act, Protection of Persons in Care Act, and the Public Health Act.

The AHS external website [7] identified a list of policies, directives and bylaws4

Also included on the website are links to non-AHS online resources to help preceptors prepare for placements, both interprofessional (e.g. www.practiceeducation.ca, www.preceptor.ca) or discipline specific (e.g. links to health profession regulatory body documents regarding student supervision).

to be reviewed by students and instructors prior to beginning a placement with AHS. This suite of policies, directives and bylaws protect patients and their health information (e.g. disclosure of harm, consent to treatment, privacy of patient information), and AHS employees and other persons acting on behalf of AHS including students (e.g. abuse or harassment, exposure to blood or body fluids, workplace safety).

AHS internal (limited access to AHS employees) website AHS internal website (intranet) failed to yield policies related to student placements or IP practice education under either Corporate Policies or Clinical Policies.

Legacy external (public) websites The legacy external websites either contained limited information about student placements and provided the user with a link to the AHS external website or automatically redirected to the AHS external website.

3 Eligible students are from accredited education programs and enrolled in professions regulated under the Health Professions Act, Health Disciplines’ Act, or Physiotherapy Act. 4 Policies and Directives: Access to Information, Communications, Delegation of Authority and Responsibilities for Compliance with FOIP and the HIA, Information Technology Acceptable Use, Occupational Exposure to Blood and Body Fluids, Parking, Protection and Privacy of Health and Personal Information, Safe Disclosure, Transmission of Information by Fax or E-mail, Workplace Abuse and Harassment, Workplace Health and Safety Clinical Policies and Procedures: Bridge Supply of Medication for Discharged Patients, Consent to Treatment/Procedure(s), Disclosure of Harm Directives: Duties and Reporting Under the Protection of Persons in Care Act Bylaws and Code of Conduct: Code of Conduct, Conflict of Interest Bylaw


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Legacy internal (limited access to employees of former legacy organizations) websites The legacy internal websites to which the researcher has access,5 yielded a number of former health region level (Capital Health Region, David Thompson Health Region) or facility level (Alberta Hospital Edmonton, Covenant Health, Royal Alexandra Hospital) policies related to student placements. The majority of the policies address process and expectations (e.g. accountabilities of educational institutions), definitions (e.g. level of supervision, preceptor), general principles (e.g. contracts, criminal record checks), procedures (e.g. placement requests, identification badges), legislation and references. Although the majority of these policies address the role of students (with a policy for each discipline e.g. physical therapy, occupational therapy) within the healthcare setting and the role of employees as preceptors, none make reference to IP practice education with one exception which discusses interdisciplinary scope of practice.6

Overview of student placement policies outside AHS

Few of the policies acknowledged that managers may require staff to complete a preceptorship-training program prior to commencing the role of preceptor.

A focused literature search yielded student placement policies in the United Kingdom, Australia and British Columbia.

Comprehensive standards to support learning and assessment in nursing and midwifery practice have been developed by the Nursing and Midwifery Council (the nursing and midwifery regulator for England, Wales, Scotland, Northern Ireland and the Islands [122]). These mandatory requirements include the demonstration by potential preceptors of the integration of the discipline’s practice competencies into their own practice. These requirements also clearly outline the preceptor’s responsibility for developing and ensuring the practice competence of students [13]. Additionally, preceptors must, on an ongoing basis, demonstrate the knowledge, skills and competence to support student learning as defined by the standards [121]. To aid student placements, a register of qualified preceptors is available to both practice settings and educational institutes [121]. The standards also include requirements to enable effective preceptorship, such as ensuring preceptors have access to a network of support to assist them fulfill their responsibilities [121]. The underpinning principles of these standards stipulate the preceptor’s ability to support interprofessional learning by maintaining professional boundaries that are sufficiently flexible for providing interprofessional learning and care [121].

Region specific policies (e.g. [120]) include explicit statements regarding the opportunity for students to learn about the whole patient experience by working within a multi-disciplinary or interprofessional team. A comprehensive Australian policy [15] defines IP practice and assigns accountabilities and responsibilities for the implementation of IP practice. This includes supporting shared learning opportunities across professional boundaries for students. The policy also describes ways in which the organizations’ values of collaboration, care and respect can be put into action, evidenced and evaluated.

BC Academic Health Council (BCAHC), Practice Education Committee [25,26] has developed and made publicly available checklists for program/service unit leaders and corporate leaders (e.g. senior executive team, academic leaders, practice education leaders) within organizations to identify potential gaps in IP practice

5 Alberta Alcohol and Drug Abuse Commission, Calgary Health Region, Capital Health Region, David Thompson Health Region, East Central Health Region 6 The Royal Alexandra Hospital and former Capital Health Region released guidelines in 2004 to outline the principles, process and documentation to be used when determining appropriate limits or expansions to the scope of practice for all regulated health professionals (Interdisciplinary Guidelines for Determining Appropriate Scope of Practice, Number 81).


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education strategy, infrastructure and processes. Communication of the assessment may increase an organization’s understanding of IP practice education issues and opportunities, and support more systematic and strategic management of this resource across the organization.

Conclusion Organizational practice standards and policies ensure the infrastructure supports preceptorship and IP practice education. Learning and assessment in practice standards [94,140], and policies and frameworks that outline expectations of preceptors and guide preceptor selection criteria and qualification requirements [27,30,57,94,140,176] also support preceptorship. A framework for preceptorship provides evidence of competency and addresses accountability issues [94].

Given limited access to the legacy websites, a full understanding of the extent of IP practice education policies and standards in AHS is not possible. This is unfortunate since, until AHS has adopted and released a province wide organizational set of policies and standards around IP practice education, the former legacy policies and standards are in place. An integral aspect of these provincial policies and standards, once in place, must include clearly identified accountability for maintaining and monitoring their implementation and effectiveness. The current lack of an integrated, standard set of policies and practice standards around IP practice education within AHS and between AHS and its partners (e.g. educational institutions, other healthcare service providers) challenges ensuring equitable patient care for all Albertans. Therefore, it is urged that adoption of the draft Student Placement Policy be implemented at the earliest possible time.

VI. Use of HSPnet for IP practice education coordination The Health Sciences Placement Network (HSPnet) was developed by the British Columbia Academic Health Council (BCAHC), for use in British Columbia. A National HSPnet Alliance was formed to allow other provinces to access the system. Through the alliance, a lead agency in each province or jurisdiction enters into an agreement with the BCAHC to license HSPnet on behalf of user agencies within the lead agency’s province or jurisdiction. The alliance is governed by the National HSPnet Steering Committee. This committee is responsible for ensuring the success of the shared infrastructure through financial sustainability and achievement of mutual goals. National policies ensure compliance with provincial and federal legislation on privacy and security of personal information, consistency of policy and procedures across user governments and lead agencies, and effectiveness of infrastructure operations [85].

What is the Health Sciences Placement Network (HSPnet)? HSPnet is an electronic system for improving the management of practice education activities for health sciences students [86]. Practice education management activities include coordinating clinical placements (also known as preceptorships, clerkships, internships, or practica) and related activities such as policy management and agreement tracking, preceptor recognition, instructor assignment and scheduling, collaborative resolution of scheduling conflicts and IP placements. HSPnet streamlines manual processes for managing practice education, improves communications and information sharing, and brings together multiple local data sets to provide better system-wide information [87].

Student placements that cross provincial borders cannot be facilitated through HSPnet. HSPnet provides the user the option to view placements in other provinces but there is limited functionality for inter-provincial placements. There is speculation it is unlikely provinces will share placements through HSPnet because of limited health workers and fear of poaching.


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HSPnet goals The goals of HSPnet are to [88]:

• Increase the availability and quality of practice education opportunities for students

• Streamline processes and improve coordination and communication among agencies that place and receive students

• Identify untapped opportunities and provide access to a greater range of placement settings including rural and community

• Support evaluation and improvement of learner outcomes

• Enhance the profile and priority of practice education

Current status of HSPnet in Alberta (HSPnet AB) The majority of student placements in AHS are tracked in HSPnet AB [8]. Within AHS, Health Professions Strategy and Practice is responsible for the administration of HSPnet AB. Alberta Health and Wellness is the lead agency and funder of HSPnet AB.

HSPnet AB is not used consistently by educational institutes throughout the province. Nursing faculties are currently the highest users of HSPnet in Alberta. Other professions are increasing use for student placements but are sometimes challenged with the HSPnet scheduling tools. Additionally, HSPnet is not fully “automated” since the receiving coordinator often must act as intermediary between HSPnet and the receiving service area. The receiving coordinator sends emails to service areas indicating what student placements are available and requesting a response. The receiving coordinator then negotiates placements that have not been accepted during the initial email communication.

HSPnet AB is still organized by the former health regions hampering the provincial integration of student placements. There would be considerable cost to update the database to accommodate the new provincial structure and that cost would be incurred by Alberta Health Wellness. There is also some reluctance from BCAHC to undertake this extensive change because all other provinces are still organized by “regions.”

Future goals of HSPnet AB Future goals for HSPnet AB within AHS are to implement HSPnet as widely as possible in order to track and coordinate placements (e.g. amount of time of student placements in AHS; details of placements such as discipline, outcomes), and standardize use among professions.

VII. Performance monitoring BC Practice Education Initiative developed an excellent background paper on quality practice education [119]. The paper highlights the importance of having appropriate structures and processes in place to support quality practice education including appropriate data infrastructure and metrics to measure practice education performance and outcomes. Ongoing evaluation of the effectiveness of practice education programs [72,133,140] assists healthcare facilities, educational institutes and other stakeholders determine what is working well and what should be changed or eliminated in the program.

While the need for monitoring practice education performance is recognized, there is limited information in the literature on what needs to be measured and how; reliable measures or assessment tools don’t exist. Most commonly, programs capture practice education capacity (numbers of students that can be accommodated in


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various locations at various times), numbers of students actually placed, preceptors recruited and trained, or in some cases, number of students hired into permanent positions at their clinical placement site [119]. These measures capture activities rather than outcomes, which may provide little insight into areas for improvement [119]. Formal evaluation of preceptors has been proposed as a way to assess their effectiveness in advancing the student’s intellectual growth, professional development and personal communication, and how the preceptor role models the profession [57,138,140,147,176]. This can assist preceptors improve their skills, anticipate potential problems and grow [147]. There is, however, a lack of suitable evaluation tools to capture this kind of feedback [147] and students may be reluctant to disclose information that reflects poorly on their preceptors. Other performance measures may include readiness of preceptors for precepting students including evaluation of preceptor education and support programs. Student satisfaction with their practice education experience is another important performance measure [119]. Academic institutions typically solicit feedback from students about their practice education experience, but this information is not generally communicated to practice sites for improvement purposes.

Newberry and Mickelson [119] has drawn attention to the fact that the broader organizational environment needs to be set up for high quality practice education. This means leadership, strategic planning, facilities and equipment, and policies all need to support practice education and require ongoing monitoring to ensure desired performance. BC Academic Health Council [25,26] has developed two self assessment checklists for building quality in practice education. The checklists are designed to “support a comprehensive assessment of practice education infrastructure, as well as practice education quality review, planning, and improvement.” Both checklists cover the areas of leadership, strategy and engagement; building capacity and tracking performance; collaboration and innovation; and delivery and support from an organizational level and unit level, respectively. Completing these checklists is an excellent starting point for identifying areas of strength and areas in need of improvement.

Conclusion Interprofessional collaboration has been shown to improve workplace quality [161] and provider satisfaction [161,163]. When collaborative IP partnerships are embraced, especially those that cross multiple organizational levels, there is a break down in professional barriers and organizational structures. Kalisch and colleagues [95] found that improvements in practice and communication resulted in improved teamwork and decreased staff turnover and vacancy rates. Interprofessional collaboration was also found to increase job autonomy and respect from others [1]. Perceived equality across organizations and healthcare professions opens communication lines, further enhancing collaboration and the promotion of a single vision and goals.

Other outcomes of an IP collaborative effort include improved quality of patient care, especially for those with complex health issues such as mental health and chronic disease [20,79,144]. There is also evidence to support the impact of IP teams on reducing wait times and increasing access to services [20,92,139], decreasing hospitalization and readmission of patients [58,89,151], and reducing patient care costs [161]. Interprofessional teams have also been associated with improvement in quality of life [14,20,38,64,109,114,151], increase in patient self-efficacy [109], as well as improvement in clinical outcomes for diabetic patients [42], geriatric patients [37,168], and mental health patients [55,80]. Interprofessional collaboration would also allow preceptors and students to receive more support in their role by both practice (clinical and health services) and education. Role definition and clarity may also result in greater alignment with the competencies outlined by the regulatory bodies and associations.

Benefits of collaborative practice and IP practice education are also evident for students. Collaborative IP partnerships support students and increase their feeling of connectedness to other professionals [23]. Evidence


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also shows that IP placements in rural or more challenging clinical areas results in more students choosing these options [161]. Having students participate in IP practice education can also benefit organizations in recruiting healthcare professionals from new graduate pools.

Since the benefits of collaborative practice and IP practice education for the patient, student, preceptor and organization are well evidenced, the development of a concept design, in partnership with internal and external stakeholders, will expand and standardize AHS’ understanding of IP practice education issues and opportunities and support more systematic and strategic management of IP practice education. This will contribute to the AHS vision of becoming the best performing publicly funded health system in Canada and the organization’s mission to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.


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References 1. Abbott J, Allyson Y, Haxton R, Van Eyke P. 1994. Collaborative care: A professional model that influences

job satisfaction. Nursing Economic$ 12:167-9,174.

2. Alberta Health Services. 2011a. Communications Plan (Draft). Calgary, AB: Alberta Health Services Communications Department.

3. Alberta Health Services. 2011b. Engaging through social media. Retrieved May 6, 2011. http://insite.albertahealthservices.ca/3867.asp

4. Alberta Health Services. 2011c. TIPS 4 - Enabling our people to achieve excellence in providing health services. Accessed May 20, 2011. http://insite.albertahealthservices.ca/1905.asp.

5. Alberta Health Services. 2011d. Corporate policies and bylaws. Frequently asked questions. Accessed Jul 8, 2011. http://insite.albertahealthservices.ca/895.asp

6. Alberta Health Services. 2011e. Corporate policies and bylaws. Corporate policies and procedures. Accessed Jul 8, 2011. http://insite.albertahealthservices.ca/corporate-policies.asp

7. Alberta Health Services. 2011f. Student placement policies. Retrieved Jun 29, 2011. http://www.albertahealthservices.ca/3837.asp

8. Alberta Health Services. 2011g. Applying for a placement with Alberta Health Services. Retrieved Jun 29, 2011. http://www.albertahealthservices.ca/3621.asp

9. Ali M. 2009. Effective training techniques for millennials. Thesis for Master of Professional Studies, Human Resource Administration, Capstone Project.

10. Alleyne SD, Horner MS, Walter G, Fleisher SH, Arzubi E, Martin A. 2009. Mentors’ perspectives on group mentorship: A descriptive study of two programs in child and adolescent psychiatry. Academic Psychiatry 33(5):377–82.

11. Altmann TK. 2006. Preceptor selection, orientation, and evaluation in baccalaureate nursing education. International Journal of Nursing Education Scholarship 3(1):Article 1.

12. Anderson ES, Cox D, Thorpe LN. 2009. Preparation of educators involved in interprofessional education. Journal of Interprofessional Care 23(1):81-94.

13. Andrews M, Brewer M, Buchan T, Denne A, Hammond J, Hardy G, Jacobs L, McKenzie L, West S. 2010. Implementation and sustainability of the nursing and midwifery standards for mentoring in the UK. Nurse Education in Practice 10:251-5.

14. Arevian M. 2005. The significance of a collaborative practice model in delivering care to chronically ill patients: A case study of managing diabetes mellitus in a primary health care centre. Journal of Interprofessional Care 19(5):444-51.

15. Australian Capital Territory Health. 2011. Policy: Interprofessional learning, education and practice (Chief Executive Decision No. CED08-049). Downloaded Jul 8, 2011. http://www.health.act.gov.au/c/health


August 2011 C28

16. Baker L, Egan-Lee E, Leslie K, Silver I, Reeves S. 2010. Exploring an IPE faculty development program using the 3-P model. Journal of Interprofessional Care 24(5):597-600.

17. Baker L, Egan-Lee E, Martimianakis MA, Reeves S. 2011. Relationships of power: Implications for interprofessional education. Journal of Interprofessional Care 25:98-104.

18. Barnett T, Cross M, Shahwan-Akl L, Jacob E. 2010. The evaluation of a successful collaborative education model to expand student clinical placements. Nurse Education in Practice 10:17–21.

19. Barr H. 2009. An anatomy of continuing interprofessional education. Journal of Continuing Education in the Health Professions 29(3):147-50.

20. Barrett J, Curran V, Glynn L, Goodwin M. 2007. CHSRF Synthesis: Interprofessional collaboration and quality primary healthcare. Ottawa, ON: Canadian Health Services Research Foundation.

21. Barton S, Sommerfeldt S, VanderZalm J. 2010. Three perspectives of interprofessional clinical learning: How is this different from what we already do? Presentation to the Alberta Health Services Interprofessional preceptor support and development workshop.

22. Bassendowski S, Layne J, Lee L, Hupaelo T. 2010. Supporting clinical preceptors with interprofessional orientation sessions. Journal of Allied Health 39(1):23-8.

23. BC Academic Health Council. 2004. Interprofessional rural program of BC final report. Retrieved May 6, 2011. http://www.bcahc.ca/pdf/IRPbc-FinalReport-Nov04.pdf

24. BC Academic Health Council. 2008a. Advancing Practice Education in British Columbia. Draft Strategic Plan. Practice Education Committee. Retrieved Jul 13, 2011. www.bcahc.ca

25. BC Academic Health Council. 2008b. Building quality in practice education. Self-assessment checklist for clinical program and service unit leaders in health authorities. Practice Education Committee. Retrieved Sep 9, 2010. http://www.hspcanada.net/docs/quality_indicators/clinicalleaderschecklist.pdf

26. BC Academic Health Council. 2008c. Building quality in practice education. Self-assessment checklist for corporate leaders in health authorities. Practice Education Committee. Retrieved Sep 9, 2010. http://www.hspcanada.net/docs/quality_indicators/corporateleaderschecklist.pdf

27. BC Preceptor Development Initiative. 2008. Final Evaluation Report. BC Academic Health Council. Retrieved Aug 17, 2010. www.bcahc.ca

28. Beaubien JM, Baker DP. 2004. The use of simulation for training teamwork skills in health care: How low can you go? Quality and Safety in Health Care 13(S1):51-6.

29. Besner J, Lait J. 2011. Creating enticing environments for teaching and learning. Research report submitted to Alberta Health and Wellness Health Workforce Action Plan: Building Education and Clinical Capacity Fund.

30. Black D. 2009. Job planning for consultant trainers. British Journal of Hospital Medicine 70(5):294-5.

31. Blankenbaker SE. 2005. Mentor training in a military nurse corps. Journal for Nurses in Staff Development 21(3):120-5.


August 2011 C29

32. Bourbonnais FF, Kerr E. 2007. Preceptoring a student in the final clinical placement: Reflections from nurses in a Canadian Hospital. Journal of Clinical Nursing 16(8):1543-9.

33. Bradley C, Erice M, Halfer D, Jordan K, Lebaugh D, Opperman C, Owen KL, Stephen J. 2007. The impact of a blended learning approach on instructor and learner satisfaction with preceptor education. Journal for Nurses in Staff Development 23(4):164-70.

34. Brooks MV, Niederhauser VP. 2009. Preceptor expectations and issues with nurse practitioner clinical rotations. Journal of the American Academy of Nurse Practitioners 22:573-9.

35. Buring SM, Bhushan A, Broeseker A, Conway S, Duncan-Hewitt W, Hansen L, Westberg S. 2009. Interprofessional education: Definitions, student competencies, and guidelines for implementation. American Journal of Pharmaceutical Education 73(4):Article 59.

36. Burns HK, Northcutt T. 2009. Supporting preceptors: A three-pronged approach for success. The Journal of Continuing Education in Nursing 40(11):509-13.

37. Burns R, Nichol LO, Martindale-Adams J, Graney MJ. 2000. Interdisciplinary geriatric primary care evaluation and management: two-year outcomes. Journal of the American Geriatric Society 48:8-13.

38. Callahan CM, Boustani MA, Unverzagt FW, Austrom MG, Damush TM, Perkins AJ, et al. 2006. Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial. JAMA 295(18):2148–57.

39. Campbell SH, Hawkins JW. 2007. Preceptor rewards: How to say thank you for mentoring the next generation of nurse practitioners. Journal of the American Academy of Nurse Practitioners 19:24–29.

40. Canadian Nursing Association. 2004. Achieving excellence in professional practice. A guide to preceptorship and mentoring. Canadian Nurses Association. Retrieved Aug 18, 2010. http://www.cna-aiic.ca/cna/

41. CapitalCare Norwood. n.d. Shadowing guidelines.

42. Chin MH, Cook SJL, Drum ML, Jin L, Guillen M, Humilkowski CA, et al. 2004. Improving diabetes care in Midwest community health centers with the Health Disparities Collaborative. Diabetes Care 27:2-8.

43. Clinical and Translational Science Awards Consortium. 2011. Principles of community engagement. Retrieved Sep 12, 2011. http://www.atsdr.cdc.gov/communityengagement/pdf/PCE_Report_508_FINAL.pdf

44. Cockerline G, Yearwood D. 2009. Perceptual modalities: The interface between the students and web-based learning. Proceedings of EDULEARN09 Conference. 6th-8th July 2009, Barcelona, Spain.

45. Council of University Teaching Hospitals. 2001. Strategy paper. Models and best practices in recognizing and supporting preceptors and mentors. Retrieved Aug 27, 2010. http://www.bcahc.ca/pdf/STRAT-F.pdf

46. D’Avray L, Gill E, Coster S. 2007. Interprofessional learning in practice in South East London. In Piloting Interprofessional Education. Four English Case Studies. Barr H (editor). King’s College London. Higher Education Academy Health Sciences and Practice. Retrieved Sep 13, 2010. http://www.health.heacademy.ac.uk/rp/publications/occasionalpaper


August 2011 C30

47. Dalton L, Bull R, Taylor S, Galbraith K, Marriott J, Howarth H. 2007. Evaluation of the national pharmacy preceptor education program. Australian Journal of Rural Health 15:159-65.

48. Danielsson A, Sundin-Andersson C, Hov R, Athlin E. 2010. Norwegian and Swedish preceptors’ views of their role before and after taking part in a group supervision program. Nursing and Health Sciences 11:107–13.

49. Davey R, Ham V. 2010. “It's all about paying attention!” … but to what? The '6 Ms' of mentoring the professional learning of teacher educators. Professional Development in Education 36(1):229-44.

50. Deutschlander S, Suter E. unpublished. Interprofessional (IP) mentoring as an IP education strategy. Alberta Health Services.

51. DeCicco J. 2008. Developing a preceptorship/mentorship model for home health care nurses. Journal of Community Health Nursing 25:15–25.

52. Delahoyde T. 2009. Generational differences of baccalaureate nursing students’ preferred teaching methods and faculty use of teaching methods. Dissertation College of Saint Mary PhD Health Professions Education.

53. Dewolfe JA, Laschinger S, Perkin C. 2010. Preceptors’ perspectives on recruitment, support, and retention of preceptors. Journal of Nursing Education 49(4):198-206.

54. Diaz DP. 2002. Online drop rates revisited. The Technology Source Archives at University of North Carolina. Retrieved Jun 21, 2011. http://technologysource.org/article/online_drop_rates_revisited/

55. Dillard DA, Christopher D. 2007. The Southcentral Foundation depression collaborative. International Journal of Circumpolar Health 66(1):45-53.

56. Doty RE. 2010. Getting started as a pharmacy preceptor. American Pharmacists Association. Retrieved Jun 16, 2011. http://www.pharmacist.com/AM/Template.cfm?Section=Home2&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=26027

57. Eddy S. 2010. Lessons learned from formal preceptorship programs. Creative Nursing 16(4):198-9.

58. Eggert GM, Zimmer JG, Hall WJ, Friedman B. 1991. Case management: A randomised controlled study comparing a neighbourhood team and a centralized individual model. Health Services Research 26(4):471-507.

59. Fanning RM, Gaba DM. 2007. The role of debriefing in simulation-based learning. Simulation in Healthcare 2(2):115-25.

60. Feldman MD, Huang L, Guglielmo BJ, Jordan R, Kahn J, Creasman JM, Wiener-Kronish JP, Lee KA, Tehrani A, Yaffe K, Brown JS. 2009. Training the next generation of research mentors: The University of California, San Francisco, Clinical and Translational Science Institute Mentor Development Program. Clinical and Translational Science 2(3):216-21.

61. Flynn AA, MacKinnon GE. 2008. Assessing capacity of hospitals to partner with academic programs for experiential education. American Journal of Pharmaceutical Education 72(5):Article 116.


August 2011 C31

62. Frankola K. N.D. 2001. Why online learners drop out. Workforce HR trends and tools for business results. Retrieved June 16, 2011. http://www.kfrankola.com/1894/7901.html

63. Geist LJ, Cohen MB. 2010. Mentoring the mentor: Executive coaching for clinical departmental executive officers. Academic Medicine 85(1):23-5.

64. Gilbody S, Bower P, Fletcher J, Richards D, Sutton AJ. 2006. Collaborative care for depression: A cumulative meta-analysis and review of longer-term outcomes. Archives of Internal Medicine 166: 2314-21.

65. Glenrose 3A IPCLU. Interprofessional appraisal for student clinicians.

66. Golding B, Brown M, Foley A. 2009. Informal learning: A discussion around defining and researching its breadth and importance. Australian Journal of Adult Learning 49(1):34-56.

67. Goldszmidt MA, Zibrowski EM, Watling CJ. 2009. Fostering education scholarship: The mentored research group. Medical Education 43:1084.

68. Gordon VN, Steele MJ. 2005. The advising workplace: Generational differences and challenges. NACADA Journal 25(1):26-30.

69. Halliday–Wynes S, Beddie F. 2009. At a glance: Informal learning. Commonwealth of Australia. Department of Education, Employment and Workplace Relations. National Centre for Vocational Education Research, National Vocational Education and Training Research and Evaluation Program.

70. Hallin K, Danielson E. 2008. Being a personal preceptor for nursing students: Registered Nurses’ experiences before and after introduction of a preceptor model. Journal of Advanced Nursing 65(1):161-174.

71. Hansen RC. 2006. SPHERE Simulated Patient Health Environment for Research and Education. A clinical simulation project to enhance health education practice in Southwest Alberta. Project Final Report.

72. Happell B. 2009. A model of preceptorship in nursing: Reflecting the complex functions of the role. Nursing Education Perspectives 30(6):372-6.

73. Hardy B, Hudson B, Waddington E. 2003. Assessing strategic partnership: The partnership assessment tool. Strategic Partnering Taskforce: London, ON. Retrieved May 6, 2011. http://www.communities.gov.uk/documents/localgovernment/pdf/135112.pdf

74. Harper B. 2009. Engage sites and build study visibility through good effective communication practices. Next Generation Pharmaceutical 16. Retrieved May 6, 2011. http://www.ngpharma.com/article/Engage-Sites-and-Build-Study-Visiblity-Through-Good-Effective-Communication-Practices/

75. Hawke M, Ferguson L. 2002. Saskatoon District Health Preceptorship Pilot Program. Final Report.

76. Hawke M. 2003. Saskatoon District Health Preceptorship Pilot Program. Follow-up Report.

77. Hawke M. 2004. Saskatoon District Health Preceptorship Pilot Program. Follow-up Survey Report.

78. Heale R, Mossey S, Lafoley B, Gorham R. 2009. Identification of facilitators and barriers to the role of a mentor in the clinical setting. Journal of Interprofessional Care 23(4):369–79.


August 2011 C32

79. Health Council of Canada. 2009. Teams in action: Primary healthcare teams for Canadians. www.Healthcouncilcanada.ca/teamsinaction.pdf Retrieved Mar 5, 2010.

80. Hedrick SC, Chaney EF, Felker B, Liu CF, Hasenberg N, Heagerty P, et al. 2003. Effectiveness of collaborative care depression treatment in Veterans’ Affairs primary care. Journal of General Internal Medicine 18:9-16.

81. Henderson A, Fox R, Malko-Nyham K. 2006. An evaluation of preceptors’ perceptions of educational preparation and organizational support for their role. The Journal of Continuing Education in Nursing 37(3):130-6.

82. Herbert C, Best A. 2011. It’s a matter of values: Partnership for innovative change. Healthcare papers 11(2):31-7.

83. Ho K, Jarvis-Selinger S, Borduas F, Frank B, Hall P, Handfield-Jones R, et al. 2008. Making interprofessional education work: The strategic roles of the academy. Academic Medicine 83(10):934-40.

84. HSPnet. 2011a. Health Sciences Placement Network. Retrieved June 30, 2011 @ 12:51 p.m. http://www.hspcanada.net/index.asp

85. HSPnet. 2011b. National HSPnet policies. Retrieved Jun 30, 2011. http://www.hspcanada.net/docs/Policies_Consent/HSPnet_Policies.pdf

86. HSPnet. 2011c. Managing practice education. Retrieved May 6, 2011. http://www.hspcanada.net/managing/index.asp

87. HSPnet. 2011d. About HSPnet: FAQs. Retrieved Jun 30, 2011. http://www.hspcanada.net/about/faqs.asp

88. HSPnet. 2011e. About HSPnet: Goals and objectives. Retrieved Jun 30, 2011. http://www.hspcanada.net/about/index.asp

89. Hughes SL, Weaver FM, Giobbie-Hurder A, Manheim L, Henderson W, Kubab JD, et al. 2000. Effectiveness of team-managed home-based primary care: A randomized multicenter trial. JAMA 284(22):2877-85.

90. Hyrkas K, Shoemaker M. 2007. Changes in the preceptor role: Re-visiting preceptors’ perceptions of benefits, rewards, support and commitment to the role. Journal of Advanced Nursing 60(5):513-24.

91. International Association for Public Participation. 2007. IAP2 Spectrum of Public Participation. International Association for Public Participation: Thornton, Colorado.

92. Jackson G, Gater R, Golderberg D, Tantum D, Loftus L, Taylor H. 1993. A new community mental health team based in primary care: A description of the service and its effect on service use in the first year. British Journal of Psychiatry 162:375-84.

93. Johnson MO, Subak LL, Brown JS, Lee KA, Feldman MD. 2010. An innovative program to train health sciences researchers to be effective clinical and translational research mentors. Academic Medicine 85:484-9.

94. Jones S, Maxfield M, Levington A. 2010. A mentor portfolio model for ensuring fitness for practice. Nursing Management 16(10):28-31.


August 2011 C33

95. Kalisch BJ, Curley M, Stefanov S. 2007. An intervention to enhance nursing staff teamwork and engagement. The Journal of Nursing Administration 37:77-84.

96. Kemp PR, O’Keefe RD. 2003. Improving teaching effectiveness: Some samples from a program for the enhancement of teaching. College Teaching 51(3):111-4.

97. Kemper NJ. 2007. Win-win strategies help relieve preceptor burden. Nursing Management 38(2):10-2.

98. Kennedy K. 2011. Personal communiqué (email).

99. Kreulen GJ, Bednarz PK, Wehrwein T, Davis J. 2008. Clinical education partnership: A model for school district and college of nursing collaboration. School Nursing 24:360-369.

100. Lait J, Suter E, Arthur N, Deutschlander S. 2011. Interprofessional mentoring: Enhancing students’ clinical learning. Nursing Education in Practice 11:211-215.

101. Lalley JP, Gentile JR. 2009. Adapting instruction to individuals: Based on the evidence, what should it mean? International Journal of Teaching and Learning in Higher Education 20(3): 462-75.

102. Laschinger HS, Finegan J. 2005. Using empowerment to build trust and respect in the workplace: A strategy for addressing the nursing shortage. Nursing Economics 23(1):6-12.

103. Leonard M, Graham S, Bonacum D. 2004. The human factor: The critical importance of effective teamwork and communication in providing safe care. Quality and Safety in Health Care 13(S1):85-90.

104. Livingstone DW. 1999. Exploring the icebergs of adult learning: Findings of the first Canadian survey of informal learning practices. The Canadian Journal for the Study of Adult Education 13(2):49.

105. Livingstone DW. 2001. Adults’ informal learning: Definitions, findings, gaps, and future research. NALL Working Paper #22. University of Toronto. Ontario Institute for Studies in Education. New Approaches to Lifelong Learning.

106. MacIntosh J, McCormack D. 2001. Partnerships identified within primary health care literature. International Journal of Nursing Studies 38:547-55.

107. MacPhee M. 2009. Developing a practice-academic partnership logic model. Nursing Outlook 57:143-7.

108. MacPhee M, Wejr P, Semeniuk P, Scarborough K. 2009. Practice and academic nurse educators: Finding common ground. International Journal of Nursing Education Scholarship 6(1):1-18.

109. Maddigan SL, Majumdar SR, Guirguis LM, Lewanczuk RZ, Lee TK, Toth EL, et al. 2004. Improvements in patient-reported outcomes associated with an intervention to enhance quality of care for rural patients with type 2 diabetes: Results of a controlled trial. Diabetes Care 27:1306–12.

110. Marriott J, Taylor S, Simpson M, Bull R, Galbraith K, Howarth H, Leversha A, Best D, Rose M. 2005. Australian national strategy for pharmacy preceptor education and support. Australian Journal of Rural Health 13:83-90.

111. Marshall M, Gordon F. 2005. Interprofessional mentorship: Taking on the challenge. Journal of Integrated Care 13(2):38–43.


August 2011 C34

112. Martindale RG, McClave S, Heyland D, August D. 2010. Developing a mentoring program in clinical nutrition. Journal of Parenteral and Enteral Nutrition 34(S1):70S-77S.

113. Mayhall R. n.d. How to develop a communications plan. Retrieved May 4, 2011. http://www.hieran.com/comet/index.html

114. McAlister FA, Lawson FME, Teo KK, Armstrong PW. 2001. A systematic review of randomized trials of disease management programs in heart failure. The American Journal of Medicine 110(5):378–84.

115. McCormack D, Buck DM, McGraw B. 2010. A partnership model evolves from a living inventory of engagement. Nursing Leadership 23(4):61-80.

116. McCrary NE, Mazur JM. 2010. Conceptualizing a narrative simulation to promote dialogic reflection: Using a multiple outcome design to engage teacher mentors. Educational Technology Research and Development 58:325-42.

117. Michael O. 2008. Mentoring mentors as a tool for personal and professional empowerment in teacher education. International Journal of Evidence Based Coaching and Mentoring 6(1):1-18.

118. Moscato SR, Miller J, Logsdon K, Weinberg S, Chorpenning L. 2007. Dedicated education unit: An innovative clinical partner education model. Nurse Outlook 55: 31-7.

119. Newberry J, Mickelson G. 2007. Indicators of practice education quality in health care organizations: A literature review. BC Practice Education Initiative, Developing quality indicators for health care environments.

120. North West National Health Service. 2008. Practice Placement Policy for Pre-Registration Diploma and Degree Nursing Undergraduate Programmes (Version 3). Retrieved Jul 8, 2011. http://www.cmft.nhs.uk/directorates/mentor/NEW%20SITE/documents/hubandspokepolicyDec08.pdf

121. Nursing and Midwifery Council. 2008. Standards to support learning and assessment in practice. NMC standards for mentors, practice teachers and teachers. Retrieved July 6, 2011. http://www.nmc-uk.org/Documents/Standards/nmcStandardsToSupportLearningAndAssessmentInPractice.pdf

122. Nursing and Midwifery Council. 2011. About us. Accessed Jul 14, 2011. http://www.nmc-uk.org/About-us/

123. Online IPE: A virtual learning centre. Retrieved Feb 10, 2011. http://www.onlineipe.com/index.php

124. Parsons R. 2007. Improving preceptor self-efficacy using an online educational program. International Journal of Nursing Education Scholarship 4(1):Article 21.

125. Paterson M, Grandjean C. 2008. The bridge to practice model: A collaborative program designed for clinical experiences in baccalaureate nursing. Nursing Economics 26(5):302-309.

126. Patterson S, Barton S, Damant R, Dyer D, Guirguis L, Gushue S, Hall M, McFarlane L, Mulholland S, Kovacs Burns K, Nicholas D, Pimlott J, Reynolds P, Sommerfeldt S, Stayko P, VanderZalm J, Wong W. n.d.a. Building clinical education capacity with interprofessional clinical learning units across the continuum of care (IPCLU Project). Project summary.

127. Patterson S, Kwan J, Culling J. n.d.b. Building clinical education capacity with interprofessional clinical learning units across the continuum of care (IPCLU Project).


August 2011 C35

128. Pearson P, Dickinson C, Steven A, Dawson P. 2007. Towards a common goal: Developing practice-based interprofessional education in North East England. In Piloting Interprofessional Education. Four English Case Studies. Barr H (editor). King’s College London. Higher Education Academy Health Sciences and Practice. Retrieved Sep 13, 2010. http://www.health.heacademy.ac.uk/rp/publications/occasionalpaper

129. Pfund C, Pribbenow CM, Branchaw J, Lauffer SM, Handelsman J. 2006. The merits of training mentors. Science 311:473-4.

130. Phillips JM. 2006. Preparing preceptors through online education. Journal for Nurses in Staff Development 22(3):150-6.

131. Polin L, Atwood-Blaine D, Bates K, Brattan P, Burris J, Caccamise J, et al. 2001. Lateral mentoring. Pepperdine University Online Master of Arts in Educational Technology. Retrieved Sep 14, 2011. http://cadres.pepperdine.edu/mentorct/cadre2/Lateral_Mentoring.pdf

132. Practice Education Collaborative of BC. 2007. Managing practice education. BC Academic Health Council, Practice Education Committee: Vancouver, BC. Retrieved May 6, 2011. http://www.hspcanada.net/docs/peg/managingpracticeeducation.pdf

133. Ramani S, Gruppen L, Kachur EK. 2006. Twelve tips for developing effective mentors. Medical Teacher 28(5):404-8.

134. Riley J, Beal J, Levi P, McCausland M. 2002. Revisioning nursing scholarship. Journal of Nursing Scholarship 34:383-389.

135. Riley-Doucet C. 2008. A self-directed learning tool for nurses who precept student nurses. Journal for Nurses in Staff Development 24(2):e7-e14.

136. Rudolph JW, Simon R, Dufresne RL, Raemer DB. 2006. There’s no such thing as “nonjudgmental” debriefing: A theory and method for debriefing with good judgment. Simulation in Healthcare 1(1):49-55.

137. Sambunjak D, Marusic A. 2009. Mentoring: What’s in a name? JAMA 302(23):2591-2.

138. Sambunjak D, Straus SE, Marusic A. 2010. A systematic review of qualitative research on the meaning and characteristics of mentoring in academic medicine. Journal of General Intern Medicine 25(1):72-8.

139. Samet JH, Larson M, Horton NJ, Doyle K, Winter M, Saitz R. 2003. Linking alcohol- and drug-dependent adults to primary medical care: A randomized controlled trial of a multi-disciplinary health intervention in a detoxification unit. Addiction 98:509-16.

140. Sawatzky-Girling B. 2001. A healthy cycle of preceptorship support. Strategy paper. Models and best practices in recognizing and supporting preceptors and mentors. Council of University Teaching Hospitals.

141. Scanlon A, Watt E. 2010. Developing the clinical mentor role through e-Learning. Journal for Nurses in Staff Development 26(5):220-2.

142. Scarvell JM, Stone J. 2010. An interprofessional collaborative practice model for preparation of clinical educators. Journal of Interprofessional Care 24(4):386-400.

143. Schaubhut RM, Gentry JA. 2010. Nursing preceptorship workshops: Partnership and collaboration between academia and practice. The Journal of Continuing Education in Nursing 41(4):155-60.


August 2011 C36

144. Schmitt MH. 2001. Collaboration improves quality of care: Methodological challenges and evidence from US health care research. Journal of Interprofessional Care 15:47-66.

145. Schoenfeld B. 2007. Interprofessional Clinical Placement in Rural Settings in Saskatchewan. P-CITE Evaluation Report. Retrieved Apr 21, 2011. http://www.usask.ca/ipe/activities_inventory/projects/project_detail.php?id=33

146. Scott CM, Thurston WE. 1997. A framework for the development of community health agency partnerships. Canadian Journal of Public Health 88(6):416-20.

147. Silet KA, Asquith P, Fleming MF. 2010. A National survey of mentoring programs for KL2 scholars. Clinical and Translational Science 3(6):299-304.

148. Smedley A, Penney D. 2009. A partnership approach to the preparation of preceptors. Nursing Education Perspectives 30(1):31-6.

149. Smedley AM. 2008. Becoming and being a preceptor: A phenomenological study. The Journal of Continuing Education in Nursing 39(4):185-91.

150. Smith MC, Smith TJ. 2008. Low-education adults' participation in informal learning activities: Relationships with selected demographic characteristics. Adult Basic Education and Literacy Journal 2(2):67-73.

151. Sommers LS, Marton KT, Barbaccia JC, Randolph J. 2000. Physician, nurse and social worker collaboration in primary care for chronically ill seniors. Archives of Internal Medicine 160: 1825-33.

152. Sommerfeldt SC, Barton SS, Stayko P, Patterson SK, Pimlott J. 2011. Creating interprofessional clinical learning units: Developing an acute-care model. Nurse Education in Practice 11:273-77.

153. Sowan NA, Moffatt SG, Canales MK. 2004. Creating a mentoring partnership model: A university-department of health experience. Family and Community Health 27(4):326-37.

154. Sparks RL. 2006. Learning styles - making too many “wrong mistakes”: A response to Castro and Peck. Foreign Language Annals 39(3):520-8.

155. Speers AT, Strzyzewski N, Ziolkowski LD. 2004. Preceptor preparation: An investment in the future. Journal for Nurses in Staff Development 20(3):127-33.

156. Stapleton JL, Wen HJ, Starrett D, Kilburn M. 2007. Generational differences in using online learning systems. Human Systems Management 26:99-109.

157. Stellefson ML, Hanik BW, Chaney BH, Chaney JD. 2008. Challenges for tailored messaging in health education. American Journal of Health Education 39(5):303-11.

158. Stone CL, Rowles CJ. 2002. What rewards do clinical preceptors in nursing think are important? Journal for Nurses in Staff Development 18(3):162-6.

159. Surgeoner B, Suter E, Besner J. 2010. Report on the formative evaluation of the Clinical Teaching Collaborative (CTC) program. Alberta Health Services. Health Systems and Workforce Research Unit. Nursing Strategies.


August 2011 C37

160. Suter E, Taylor L, Arthur N, Clinton M, Lait J, Deutschlander S, et al. 2008. Creating an interprofessional learning environment through communities of practice: An alternative to traditional preceptorship. Final report.

161. Suter E, Deutschlander S. 2010. Can interprofessional collaboration provide health human resources solutions? A knowledge synthesis. Calgary, AB: Health Systems and Workforce Research Unit, Alberta Health Services.

162. Tang SYF, Choi PL. 2005. Connecting theory and practice in mentor preparation: Mentoring for the improvement of teaching and learning. Mentoring and Tutoring 13(3):383-401.

163. The Health Professions Regulatory Network. 2008. Position statement on interprofessional collaborative practice. Halifax, Nova Scotia: Author.

164. Troxel D. 2009. Connections: Online preceptor education. Nursing Management 40(10):32-7.

165. Tuckman BW. 1965. Developmental sequence in small groups. Psychological Bulletin 63(6):384-99.

166. Tyler-Smith K. 2006. Early attrition among first time eLearners: A review of factors that contribute to drop-out, withdrawal and non-completion rates of adult learners undertaking eLearning programmes. Journal of Online Learning and Teaching Retrieved Jun 21, 2011. http://jolt.merlot.org/vol2no2/tyler-smith.htm

167. University of Pittsburgh, School of Pharmacy Experiential Learning Program. n.d. Experiential learning program manual. A guide for pharmacy students, preceptors and faculty. Retrieved Jul 12, 2011. http://www.pharmacy.pitt.edu/programs/PharmD/elp/PreceptorManual.pdf

168. Unutzer J, Katon W, Callahan CM, Williams Jr JW, Hunkeler E, Harpole L, et al. 2002. Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial. JAMA 288(22):2836-45.

169. Vaughn LM, Baker RC. 2008. Do different pairings of teaching styles and learning styles make a difference? Preceptor and resident perceptions. Teaching and Learning in Medicine 20(3):239-47.

170. Wakefield A, Cooke S, Boggis C. 2003. Learning together: Use of simulated patients with nursing and medical students for breaking bad news. International Journal of Palliative Nursing 9(1):32-8.

171. Washington State School Directors’ Association. The Communication Plan. Retrieved May 4, 2011. http://www.work911.com/cgi-bin/links/jump.cgi?ID=615

172. Watson S. 2000. The support that mentors receive in the clinical setting. New Education Today 20:585-92.

173. Weidinger M. 2006. Enhancing rural preceptor support and skill using an innovative interactive online support system. Final report and financial statement. Rural and Remote Pharmacy Workforce Development Program, Rural and Remote Infrastructure Grants Program. The Pharmacy Guild of Australia (Guild), The Pharmaceutical Council of WA (Participant).

174. Wheelan SA, Davidson B, Tilin F. 2003. Group development across time: Reality or Illusion? Small Group Research 34(2):223-45.

175. Willging PA, Johnson SD. 2004. Factors that influence students’ decision to dropout of online courses. The Journal of Asynchronous Learning Networks 8(4):105-18.


August 2011 C38

176. Williams LL, Levine JB, Malhotra S, Holtzheimer P. 2004. The good-enough mentoring relationship. Academic Psychiatry 28(2):111-5.

177. Wright S, Kennedy K. 2007. SPHERE Simulated Patient Health Environment for Research and Education. LPN News and Views 21(2):24-5.

178. Young L, Frost LJ, Bigl J, Clauson M, McRae C, Scarborough KS, Murphy S, et al. (2010). Nurse educator pathway project: A competency-based intersectoral curriculum. International Journal of Nursing Education Scholarship 7(1):1-13.

179. Younge O, Hagler P, Cox C, Drefs S. 2008. Time to truly acknowledge what nursing preceptors do for students. Journal for Nurses in Staff Development 24(3):113-6.


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Appendix I – Glossary The glossary is contained within the report for which this is the background paper - Interprofessional practice education within Alberta Health Services. Prepared by Health Systems and Workforce Research Unit, Health Professions Strategy and Practice, Alberta Health Services. December 2011.


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Appendix II – Opportunities for partner engagement

Opportunity Action Literature

1. Build on existing networks to recruit partners

• Identify existing networks

• Formal presentation of information at network meetings

• Informal discussions at meetings, conferences

• Engage partners from multiple levels of the organization [108,118]

2. Leverage use of a champion

• Single contact person (lead / co-lead) • Leadership often provided by a champion [83]

• Appoint senior member from each practice institution (clinical or health services) to be accountable for partnership formation and coordination [118]

• Promotes shared single vision [146]

3. Work with those individuals who volunteer and express an interest in being involved

• Encourage partners to actively participate by contributing to decision making, providing input

• Initial visit

• Engagement begins with an awareness of need for partnership [146]

• Active participation increases engagement [106]

• Initial visit identifies potentially interested partners [74]

4. Identify quick wins • Identify those activities that can be implemented quickly with success

• Clarify role expectations

• Role definition session [106,153]

• Formal documents outlining roles and responsibilities [85,178]

5. Build a structure to sustain ongoing collaboration beyond current issues/projects

• Participants to decide on a leader or co-leads

• Appoint an individual to provide support to the partnership (e.g. coordination, contacting individuals)

• Replace individuals as needed (e.g. when a partner leaves or changes a position)

• Ensure new partners are invited when new organizations or individuals are identified

• Develop realistic goals, objectives, and activities

• Routine contact [74]


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Appendix III – Possible risks during partner engagement

Risks Mitigation Literature

1. Leaving out important partners/individuals

• Use the list in this strategy as a starting point for partners to engage

• Ask others who should be involved in the partnership

2. Lack of understanding real/perceived needs and roles of partners

• Conduct a needs assessment

• Spend time with each partner organization to understand needs

• Provide opportunities for partners to contribute information on their specific needs

• Imbalance between perceived and actual needs [106]

• Insufficient consultation and planning with partners [106]

3. Territorialism/own agendas

• Effective communication regarding goals, objectives and roles of the partnership

• Some professions territorial, view collaboration as threat [19]

• Unequal power relations, health professionals do not recognize others’ expertise [17,108]

• Need to connect theoretical and research expertise with real-life wisdom and practice [115]

• Opportunity to build on the knowledge, experience, and skills that each partner offers [108,153]

• Open communication [17,34,61,74]

4. Lack of time • Attach meetings to other existing meetings/work

• Explore other options for meetings (e.g. teleconference, video conference, webex)

• Ensure efficient, well-organized meetings

5. Lack of standardization of processes across partner organizations and professional groups

• Clearly defined processes for the partnership will be required

• Glossary of terms to facilitate common language

• Evaluation

• Lack of standardization and preparation for preceptors [61]

• Common definitions important [146]

• Evaluation to monitor whether partnership’s aims and objectives are being met [73,146]


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Appendix IV – Key messages and communication strategies internal to AHS

Internal to AHS

Target Audience Key Messages Communication Medium

Senior leadership (Executive Vice President, Senior Vice President, Vice President)

• IP clinical placements are attractive to students

• Clinical placements provide an opportunity for recruitment and retention of future healthcare professionals

• IP clinical placements align with the adoption of the Canadian Interprofessional Health Collaborative (CIHC) competencies framework

• Standardization and consistency of IP practice education (e.g. policies, clinical placement database) across disciplines and across the province will improve patient and provider outcomes

• Responsibility to educate and foster learning in our organization. IP mentoring provides an opportunity to support learning

1

Fact sheet, Insite website, Leadership Matters, e-mail communication

2,3

Preceptors • Responsibility to educate and foster learning in our organization. IP mentoring provides an opportunity to support learning

• Workload can be shared by the healthcare team through IP mentoring for students

2,3

Face-to-Face, fact sheet, group discussions, Insite website, external Alberta Health Services website, e-mail communication, social media

Educators (e.g. nurse educators, other AHS educators involved with clinical placements)

• Responsibility to educate and foster learning in our organization. IP mentoring provides an opportunity to support learning

• Workload can be shared by the healthcare team through IP mentoring for students

2,3

Face-to-Face, lunch and learn events, fact sheet, group discussions, Insite website, HPSP student placement web pages, e-mail communication

Professional practice leaders • IP clinical placements align with the adoption of the CIHC competencies framework

Face-to-Face, fact sheet, group discussions, Insite website, external AHS website, Leadership Matters, e-mail communication

Rural and urban clinical placement sites (e.g. hospitals, health centres, specialty clinics)

• Need for alignment and mutual support between academic and clinical practice sites

• Standardization and consistency of IP practice education (e.g. policies, clinical placement database) across disciplines and the province will improve patient and provider outcomes


1

• Opportunity for recruitment and retention

Fact sheet, Insite website, social media


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Internal to AHS


Managers • Students are an important resource; creative ways are required to maximize their contributions in the practice setting


• Clinical placements provide an opportunity for recruitment and retention of future healthcare professionals

• IP clinical placements can re-energize and increase knowledge and skills of current staff; provides on the job professional development

Face-to-Face, fact sheet, group discussions, Insite website, external Alberta Health Services website, Leadership Matters, e-mail communication

AHS staff • Responsibility to educate and foster learning in our organization. IP mentoring provides an opportunity to support learning

• Students are an important resource; creative ways are required to maximize their contributions in the practice setting

3

Fact sheet, Insite website, e-mail communication, newsletter

Patients and families, patient advocacy groups

• IP collaborative practice has been shown to improve patient outcomes

• Patients should be actively involved as an equitable team member in their care

Fact sheet, newsletters, AHS external website, social media

Health Advisory Councils • IP collaborative practice has been shown to improve patient outcomes

Fact sheet, Insite website, e-mail communication, newsletter

1. Supported by TIP #5 Enabling one health system. See http://insite.albertahealthservices.ca/1906.asp 2. Learning, one of the new values added to AHS values. See http://insite.albertahealthservices.ca/3865.asp 3. Supported by AHS TIP #4 People supported by education, incentives, tools, and information; culture is collaborative, innovative, and learning-oriented; and plan a learning and development strategy. See http://insite.albertahealthservices.ca/1905.asp


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Appendix V – Key messages and communication strategies external to AHS

External to AHS


Educational institutions and leadership

• Alignment around goals and objectives of IP practice education along with mutual support between academic and clinical practice sites is required in the implementation of IP practice education

• Standardization and consistency of practice education (e.g. policies, clinical placement database) across disciplines and across the province will improve patient and provider outcomes. Organizational mandates and overarching government policies (e.g. FOIP) will need to be considered in standardizing policies and sharing student information

Face-to-Face, fact sheet, group discussions, newsletters, AHS website, social media

Students • Students are full members of the collaborative team

• Opportunity to experience working in a future workplace

Fact sheet, AHS website, social media

Preceptors in non-AHS clinical settings

• Responsibility as healthcare providers to educate and foster learning of students. IP mentoring provides an opportunity to support learning

• Workload could be shared with all members of the healthcare team through IP mentoring for students; Primary preceptor is from the student’s profession

Face-to-Face, fact sheet, group discussions, newsletters, AHS website, social media

Non-AHS clinical sites (e.g. long-term care, assisted living, PCNs, community pharmacies, shelters)

• Need for alignment and mutual support between academic and clinical practice sites

• Standardization and consistency of IP practice education (e.g. policies, clinical placement database) across disciplines and across the province will improve patient and provider outcomes


• Opportunity for recruitment and retention

Fact sheet, newsletters, electronic web requests, AHS website, social media

Regulatory bodies and associations

• IP collaborative practice is a component of professional competencies for all health disciplines

• Standardization and consistency of IP practice

Fact sheet, group discussions, reports, AHS website, social media


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External to AHS


education (e.g. policies, clinical placement database) across disciplines and across the province will improve patient and provider outcomes

Federal, regional, local governments

• IP clinical placements align with the adoption of the CIHC competencies framework


Community • IP clinical placements provide a mechanism for effective recruitment of healthcare providers particularly in rural areas and other more challenging healthcare specialities

• Practicum students and new healthcare providers need to be effectively linked to the community both professionally and socially to facilitate recruitment and retention


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