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      When less is more: validating a brief scale to rate interprofessional team competencies

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          ABSTRACT

          Background: There is a need for validated and easy-to-apply behavior-based tools for assessing interprofessional team competencies in clinical settings. The seven-item observer-based Modified McMaster-Ottawa scale was developed for the Team Objective Structured Clinical Encounter (TOSCE) to assess individual and team performance in interprofessional patient encounters.

          Objective: We aimed to improve scale usability for clinical settings by reducing item numbers while maintaining generalizability; and to explore the minimum number of observed cases required to achieve modest generalizability for giving feedback.

          Design: We administered a two-station TOSCE in April 2016 to 63 students split into 16 newly-formed teams, each consisting of four professions. The stations were of similar difficulty. We trained sixteen faculty to rate two teams each. We examined individual and team performance scores using generalizability (G) theory and principal component analysis (PCA).

          Results: The seven-item scale shows modest generalizability (.75) with individual scores. PCA revealed multicollinearity and singularity among scale items and we identified three potential items for removal. Reducing items for individual scores from seven to four (measuring Collaboration, Roles, Patient/Family-centeredness, and Conflict Management) changed scale generalizability from .75 to .73. Performance assessment with two cases is associated with reasonable generalizability (.73). Students in newly-formed interprofessional teams show a learning curve after one patient encounter. Team scores from a two-station TOSCE demonstrate low generalizability whether the scale consisted of four (.53) or seven items (.55).

          Conclusion: The four-item Modified McMaster-Ottawa scale for assessing individual performance in interprofessional teams retains the generalizability and validity of the seven-item scale. Observation of students in teams interacting with two different patients provides reasonably reliable ratings for giving feedback. The four-item scale has potential for assessing individual student skills and the impact of IPE curricula in clinical practice settings.

          Abbreviations: IPE: Interprofessional education; SP: Standardized patient; TOSCE: Team objective structured clinical encounter

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          Most cited references32

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          Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes.

          Poor interprofessional collaboration (IPC) can negatively affect the delivery of health services and patient care. Interventions that address IPC problems have the potential to improve professional practice and healthcare outcomes. To assess the impact of practice-based interventions designed to change IPC, compared to no intervention or to an alternate intervention, on one or more of the following primary outcomes: patient satisfaction and/or the effectiveness and efficiency of the health care provided. Secondary outcomes include the degree of IPC achieved. We searched the Cochrane Effective Practice and Organisation of Care Group Specialised Register (2000-2007), MEDLINE (1950-2007) and CINAHL (1982-2007). We also handsearched the Journal of Interprofessional Care (1999 to 2007) and reference lists of the five included studies. Randomised controlled trials of practice-based IPC interventions that reported changes in objectively-measured or self-reported (by use of a validated instrument) patient/client outcomes and/or health status outcomes and/or healthcare process outcomes and/or measures of IPC. At least two of the three reviewers independently assessed the eligibility of each potentially relevant study. One author extracted data from and assessed risk of bias of included studies, consulting with the other authors when necessary. A meta-analysis of study outcomes was not possible given the small number of included studies and their heterogeneity in relation to clinical settings, interventions and outcome measures. Consequently, we summarised the study data and presented the results in a narrative format. Five studies met the inclusion criteria; two studies examined interprofessional rounds, two studies examined interprofessional meetings, and one study examined externally facilitated interprofessional audit. One study on daily interdisciplinary rounds in inpatient medical wards at an acute care hospital showed a positive impact on length of stay and total charges, but another study on daily interdisciplinary rounds in a community hospital telemetry ward found no impact on length of stay. Monthly multidisciplinary team meetings improved prescribing of psychotropic drugs in nursing homes. Videoconferencing compared to audioconferencing multidisciplinary case conferences showed mixed results; there was a decreased number of case conferences per patient and shorter length of treatment, but no differences in occasions of service or the length of the conference. There was also no difference between the groups in the number of communications between health professionals recorded in the notes. Multidisciplinary meetings with an external facilitator, who used strategies to encourage collaborative working, was associated with increased audit activity and reported improvements to care. In this updated review, we found five studies (four new studies) that met the inclusion criteria. The review suggests that practice-based IPC interventions can improve healthcare processes and outcomes, but due to the limitations in terms of the small number of studies, sample sizes, problems with conceptualising and measuring collaboration, and heterogeneity of interventions and settings, it is difficult to draw generalisable inferences about the key elements of IPC and its effectiveness. More rigorous, cluster randomised studies with an explicit focus on IPC and its measurement, are needed to provide better evidence of the impact of practice-based IPC interventions on professional practice and healthcare outcomes. These studies should include qualitative methods to provide insight into how the interventions affect collaboration and how improved collaboration contributes to changes in outcomes.
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            The effectiveness of interprofessional education: key findings from a new systematic review.

            Over the past decade systematic reviews of interprofessional education (IPE) have provided a more informed understanding of the effects of this type of education. This paper contributes to this literature by reporting an update of a Cochrane systematic review published in this journal ten years ago (Zwarenstein et al., 1999 ). In updating this initial review, our current work involved searches of a number of electronic databases from 1999-2006, as well as reference lists, books, conference proceedings and websites. Like the previous review, only studies which employed randomized controlled trials, controlled-before and-after-studies and interrupted time series studies of IPE, and that reported validated professional practice and health care outcomes, were included. While the first review found no studies which met its inclusion criteria, the updated review located six IPE studies. This paper aims to add to the ongoing development of evidence for IPE. Despite some useful progress being made in relation to strengthening the evidence base for IPE, the paper concludes by stressing that further rigorous mixed method studies of IPE are needed to provide a greater clarity of IPE and its effects on professional practice and patient/client care.
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              Teamwork assessment in internal medicine: a systematic review of validity evidence and outcomes.

              Valid teamwork assessment is imperative to determine physician competency and optimize patient outcomes. We systematically reviewed published instruments assessing teamwork in undergraduate, graduate, and continuing medical education in general internal medicine and all medical subspecialties.
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                Author and article information

                Journal
                Med Educ Online
                Med Educ Online
                ZMEO
                zmeo20
                Medical Education Online
                Taylor & Francis
                1087-2981
                2017
                5 May 2017
                : 22
                : 1
                : 1314751
                Affiliations
                [ a ] Department of Family Medicine, Keck School of Medicine of the University of Southern California , CA, USA
                Author notes
                CONTACT Désirée A. Lie dlie@ 123456usc.edu Keck School of Medicine of the University of Southern California , 1000 S Fremont Ave., Unit 7, Building A-11, Room 11166, Alhambra, CA 91803-8897, USA
                Article
                1314751
                10.1080/10872981.2017.1314751
                5508637
                28475438
                e98e7747-a2f3-4c4e-9ff7-f235fb634ec2
                © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 December 2016
                : 29 March 2017
                Page count
                Figures: 1, Tables: 5, References: 41, Pages: 11
                Funding
                Funded by: Health Resources and Services Administration 10.13039/100000102
                Award ID: D57HP23251
                This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant #D57HP23251 Physician Assistant Training in Primary Care, 2011-2017. The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsement be inferred by HRSA, HHS, or the U.S. Government;
                Categories
                Research Article
                Research Article

                Education
                interprofessional education,team behaviors,assessment,team objective structured clinical encounter,validation,rating scale

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