Leveling the Playing Field: An Interprofessional Rural Preceptorship Pilot for Students of Nursing and Medicine

Deirdre Jackman, O. Yonge, F. Myrick, F. Janke, Jill Konkin
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Abstract

Despite the ubiquity of interprofessional education (IPE) in the health sciences, cultural barriers to collaboration and socialization across disciplines are pervasive and persistent. The Interprofessional Rural Preceptorship Pilot (IPRPP) was implemented over 18 months between 2014 and 2015, to deliver mutual, practice-based, collaborative experiences to students of nursing and medicine, and to capitalize on the multidisciplinary team ethos of rural settings in socializing these students into an interprofessional culture. Students; precepting nurses and physicians; unit managers; and faculty supplied qualitative research data through semistructured interviews and focus groups, to help determine the effectiveness of the IPRPP in achieving its ends. Thematic analysis of transcripts, field notes and memos revealed that the pilot: 1) induced all participants to reflect on cultural barriers to IPE, particularly in light of the more experienced, male physicians’ apparent reluctance to buy into the pilot or the research study; 2) sensitized medical students to the scope of practice, roles and knowledge base of registered nurses and nursing students, whom they came to value as collaborators and teachers; and 3) inspired nursing students to take the lead in arranging interprofessional experiences, and to assert their viewpoints as equals within the multidisciplinary team. It was found that liminal (transitional) spaces and the frontline relaxation of traditional hierarchies—both widely acknowledged features of rural health care settings—contributed to these outcomes. The findings show that clinical settings have a significant impact on the interprofessional socialization of nursing and medical students, with implications for the design of future IPE initiatives.
公平竞争:护理和医学专业学生的跨专业农村见习试点
尽管跨专业教育(IPE)在健康科学中无处不在,但跨学科合作和社会化的文化障碍是普遍和持久的。跨专业农村领班试点(IPRPP)在2014年至2015年期间实施了18个月,为护理和医学专业的学生提供相互的、基于实践的合作体验,并利用农村环境的多学科团队精神将这些学生融入跨专业文化。学生;教导护士和医生;部门经理;教师通过半结构化访谈和焦点小组提供定性研究数据,以帮助确定IPRPP在实现其目标方面的有效性。对笔录、现场记录和备忘录的专题分析显示,试点项目:1)促使所有参与者反思IPE的文化障碍,特别是考虑到经验更丰富的男性医生明显不愿参与试点项目或研究;2)使医学生对注册护士和护生的执业范围、角色和知识基础敏感,并将其视为合作者和教师;3)鼓励护生带头安排跨专业经验,并在多学科团队中平等地表达自己的观点。研究发现,阈限(过渡)空间和传统等级制度的前沿放松——这两个被广泛认可的农村卫生保健环境特征——促成了这些结果。研究结果显示,临床环境对护理学生和医学生的跨专业社会化有显著影响,这对未来IPE计划的设计具有启示意义。
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