Dear editor
We read with great interest the paper by Henkin et al,1 demonstrating that the use
of interprofessional bedside rounding (IBR) significantly improved nurse–physician
teamwork, particularly from the nurses’ point of view. This finding is relevant when
one takes into account the importance of interdisciplinary teamwork; a review conducted
by Epstein concluded that effective interprofessional teamwork both maximizes patient
safety and increases job satisfaction and efficiency.2 We, as medical students, believe
that inadequate emphasis is placed on interprofessional collaboration at the prequalification
phase, and therefore, we suggest that implementing IBR at the university level could
represent a method to improve teamwork between the nurses and doctors of the future.
The lack of a significant improvement in Safety Attitudes Questionnaire (SAQ) scores
of doctors following IBR implementation in Henkin et al’s study suggested that physicians’
teamwork benefited less from the exercise than that of nurses. While the reasons for
this may be multifactorial, it is possible that this attitudinal disparity relates
to hierarchical differences.3 We additionally suggest that these discrepancies in
baseline attitude may, in part, be due to an “us and them” mindset already ingrained
in both parties at the point of qualification.
Leipzig et al demonstrated that senior doctors within a multidisciplinary team were
less positively inclined toward interdisciplinary teamwork;4 however, there is evidence
to suggest that this perception is, in fact, deeply embedded at an earlier stage,
with a study indicating that negative perceptions of nurses can exist among medical
students as early as their first year of study.5 Interestingly, Carpenter has shown
that programs which promote early teamwork between different health care professions
are successful in diminishing stereotypes.6 Therefore, in order to pursue an improvement
in interprofessional practice, we believe that it may be preferable to implement interventions
such as IBR before qualification. Furthermore, it could be an effective method of
encouraging a culture of inclusivity and respect in health care students and, as a
result, could optimize the efficacy of the multidisciplinary team.
We acknowledge that integrated teaching does already exist at many UK medical and
nursing schools. Yet, from our experience as student doctors, although our “shared
learning” sessions were useful in introducing us to nursing students in a classroom
context, these were limited at promoting a sense of integration and teamwork within
a clinical setting. This is consistent with a report by Horsburgh et al stating that
“shared learning” may be ineffective, suggesting instead that “interprofessional clinical
learning” such as IBR allows students to acquire clinical knowledge and understand
the complexities of a multiprofessional environment.7
Although in the UK it is a General Medical Council requirement for medical schools
to provide opportunities “to work and learn with other health and social care professionals
and students to support interprofessional multidisciplinary working”,8 there is currently
no universal framework in place indicating how these opportunities for interprofessional
engagement should be delivered. However, Bridges et al identify “didactic, community
and clinical teaching” as the core components of medical education,9 with IBR representing
a clinical method of bringing together nursing and medical students, while providing
a true-to-life example of interprofessional practice.
Indeed, there would be challenges to the implementation of student IBR. The educational
needs of nursing and medical students differ, and as such, tailoring a teaching ward
round to suit both would require consideration. This also poses questions as to which
professional would lead the teaching. Furthermore, grouping of students may lead to
overcrowding, which may be uncomfortable for patients and inefficient for the progression
of the round. A possible solution could involve the creation of supplementary ward
rounds for educational purposes.
A pilot study commencing with a small cohort of nursing and medical students would
be useful in establishing the feasibility of student IBR. Methodology akin to that
of Henkin et al’s trial, combined with the use of Parsell and Bligh’s Readiness for
Interprofessional Learning Survey,1,10 could enable measurement of changes in interprofessional
teamwork. Also, a survey of patients present would be important to assess their perspective.
In summary, we feel that IBR, at a student level, could represent a beneficial and
clinically applicable method to cultivate interdisciplinary collaboration at an early
stage. By nurturing and sharing a more cooperative mentality in their early training
years, future doctors and nurses are more likely to work “together” rather than “alongside”
each other, ultimately resulting in better patient care.