RESEARCH ARTICLE: Exploring students' perceptions and opinions about an institutional hierarchy of healthcare professionals and its impact on their inter- professional learning outcomes
DOI:
https://doi.org/10.46542/pe.2021.211.1928Keywords:
nter-professional Learning, Institutional Hierarchy, Multidisciplinary, Stereotypes, TribalismAbstract
Context: Institutional hierarchy is a phenomenon associated with clinical tribalism. Inter-professional learning is thought to improve a healthcare team's collaboration and communication.
Aim: The aim was to evaluate student understanding of institutional hierarchy and perceptions and opinions on their participation in inter-professional learning.
Method: Using a questionnaire, this study gathered the opinions of fourth year pharmacy students who had completed two inter-professional learning sessions. Quantitative and qualitative analyses were conducted.
Results: Students (87.7%, n=50) were aware of the institutional hierarchy concept, listing the order as doctors, pharmacists, nurses then allied health. 61.4% (n=35) were willing to participate in inter-professional learning sessions. Students (70.1%, n=40) agreed that inter-professional learning sessions have added benefit to patient-centred care, and to understanding different healthcare roles in depth (82.5%, n=47) but failed in diminution of the hierarchical ideology.
Conclusions: Inter-professional learning sessions did not change students' opinions about posiGoning of doctors as the top of the healthcare institutional hierarchy.
References
Abdulrahman, M., Alsabbagh, A., Kuntze, T., Lauer, B.. & Ohlow, M.A. (2019) Impact of Hierarchy on Multidisciplinary Heart-Team Recommendations in Patients with Isolated Multivessel Coronary Artery Disease (online). Journal of clinical medicine, 8(9), 1490. https://doi.org/10.3390/jcm8091490
Braithwaite, J., Clay-Williams, R., Vecellio, E., Marks, D., Hooper, T., Westbrook, M., Westbrook, J., Blakely, B., & Ludlow, K. (2016) The basis of clinical tribalism, hierarchy and stereotyping: a laboratory-controlled teamwork experiment (online). BMJ Open, 6(7), https://doi.org/10.1136/bmjopen-2016-012467
Brazil, V. (2014) The Tribal Nature of Medicine (online). Available from: https://emergencypedia.com/2014/04/06/tribalism-in-medicine/
Buring, S.M., Bhushan, A., Broeseker, A., Conway, S., Duncan-Hewitt, W., Hansen, L., & Westberg, S. (2009) Interprofessional Education: Definitions, Student Competencies, and Guidelines for Implementation (online). American Journal Of Pharmaceutical Education, 73(4), 59. https://doi.org/10.5688/aj730459
CAIPE (The Centre for the Advancement of Interprofessional Education). (2002) What is CAIPE?. Available at: https://www.caipe.org/about-us
Carding, N. (2019) NHS hierarchies put patients at risk says CQC chief (online). Health Services Journal. Available at: https://www.hsj.co.uk/patient-safety/nhs-hierarchies-put-patients-at-risk-says-cqc-chief/7024867.article
Carney, P.A., Thayer, E.K., Palmer, R., Galper, A.B., Zierler, B., & Eiff, P. (2019) The benefits of interprofessional learning and teamwork in primary care ambulatory training settings (online). Journal of Interprofessional Education & Practice, 15, 119-126. https://doi.org/10.1016/j.xjep.2019.03.011
Darlow, B., Coleman, K., McKinlay, E., Donovan, S., Beckingsale, L., Gray, B., Neser, H., Perry, M., Stanley, J., & Pullon, S. (2015). The positive impact of interprofessional education: a controlled trial to evaluate a programme for health professional students. BMC Medical Education, 15, 98. https://doi.org/10.1186/s12909-015-0385-3
Department of Health and Social Care. (2002). The Department of Health's response to the report of the Public Inquiry into children's heart surgery at the Bristol Royal Infirmary (online). Available at: https://www.gov.uk/government/publications/the-department-of-healths-response-to-the-report-of-the-public-inquiry-into-childrens-heart-surgery-at-the-bristol-royal-infirmary
Greer, L.L., Saygi, O., Aaldering, H., & de Dreu, C.K.W. (2012) Conflict in medical teams: opportunity or danger? (online). Medical Education, 46(10), 935-942. https://doi.org/10.1111/j.1365-2923.2012.04321.x
Hammick, M. (1998) Interprofessional Education: Concept, Theory and Application (online). Journal of Interprofessional Care, 12(3), 323-332. https://doi.org/10.3109/13561829809014123
Herath, C., Zhou, Y., Gan, Y., Nakandawire, N., Gong, Y., & Lu, Z. (2017) A comparative study of interprofessional education in global health care (online). Medicine (Baltimore), 96(38), https://doi.org/10.1097/MD.0000000000007336
Hindi, A.M.K., Schafheutle, E.I., & Jacobs, S. (2017). Patient and public perspectives of community pharmacies in the United Kingdom: A systematic review (online). Health Expectations, 21(2), 409-428. https://doi.org/10.1111/hex.12639
Homeyer, S., Hoffmann, W., Hingst, P., Oppermann, R.F., & Dreier-Wolfgramm, A. (2018) Effects of interprofessional education for medical and nursing students: enablers, barriers and expectations for optimizing future interprofessional collaboration – a qualitative study. BMC Nursing, 17, 13. https://doi.org/10.1186/s12912-018-0279-x
Laming, W.H. (2003) The Victoria Climbie Inquiry: report of an inquiry by Lord Laming (online). Available at: https://www.gov.uk/government/publications/the-victoria-climbie-inquiry-report-of-an-inquiry-by-lord-laming
Mahler, C., Schwarzbeck, V., Mink, J., & Goetz, K. (2018) Students´ perception of interprofessional education in the bachelor programme 'Interprofessional Health Care' in Heidelberg, Germany: an exploratory case study. BMC Medical Education 18, 19. https://doi.org/10.1186/s12909-018-1124-3
Mathers, N., Fox N., & Hunn A. (2007). Surveys and Questionnaires. The NIHR RDS for the East Midlands / Yorkshire & the Humber (online). Available at: https://www.rds-yh.nihr.ac.uk/wp-content/uploads/2013/05/12_Surveys_and_Questionnaires_Revision_2009.pdf
National Health Service Scotland. (2013). Patient Safety Education Scenario (online). Available at: https://www.nes.scot.nhs.uk/media/1705869/ipl_patient_safety_web.pdf
Overton, A.R., & Lowry, A.C. (2013). Conflict Management: Difficult Conversations with Difficult People (online). Clinics in Colon and Rectal Surgery, 26(4), 259-264. https://doi.org/10.1055/s-0033-1356728
Sfantou, D.F., Laliotis, A., Patelarou, A.E., Sifaki- Pistolla, D., Matalliotakis, M., & Patelarou, E. (2017). Importance of Leadership Style towards Quality of Care Measures in Healthcare Settings: A Systematic Review. Healthcare (Basel, Switzerland), 5(4), 73. https://doi.org/10.3390/healthcare5040073
Smith, F. (2010) Conducting Your Pharmacy Practice Research Project. Second edition ed. London, UK: Pharmaceutical Press, pp. 75-197
Vazirani, S., Hays, R., Shapiro, M., & Cowan, M. (2005). Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses (online). American Journal of Critical Care, 14(1), 71-77. https://doi.org/10.4037/ajcc2005.14.1.71
Wilcock, M., Sibley, A., Blackwell, R., Kluettgens, B., Robens, S., & Bastian, L. (2020) Involving community pharmacists in transfer of care from hospital: Indications of reduced 30‐day hospital readmission rates for patients in Cornwall. International Journal of Pharmacy Practice. https://doi.org/10.1111/ijpp.12603
World Health Organization (1988) Learning Together to Work Together for Health. Available at: https://apps.who.int/iris/bitstream/handle/10665/37411/WHO_TRS_769.pdf;jsessionid=01D0F74D19FCF5CF850CD3497BDCD3CC?sequence=1
World Health Organization. (2010). Framework for Action on Interprofessional Education & Collaborative Practice (online). Available at: https://apps.who.int/iris/bitstream/handle/10665/70185/WHO_HRH_HPN_10.3_eng.pdf;jsessionid=7676F8DE0EBFD68ED3C841172ECBFE62?sequence=1
