Guiding medical trainees' workplace learning for interprofessional collaboration-Looking to physicians or seeing nurses?

Abstract

Introduction: Effective healthcare practice requires interprofessional collaboration (IPC) between all members of the healthcare team. Preparing healthcare trainees for IPC has proven to be difficult. Research suggests that workplace learning has a vital role in acquiring IPC competencies. However, guidance is required for trainees to make optimal use of IPC workplace learning opportunities. This study asks (1) To what extent is guidance provided to medical trainees when learning to collaborate interprofessionally?; and (2) Who provides this guidance and how?

Methods: We conducted a constructivist, qualitative study using iterative cycles of semi-structured interviews and reflexive thematic analysis. A purposive sample of medical trainees (N = 11), nurses (N = 9), advance practice clinicians (APCs)(N = 3) and attending physicians (N = 9) associated with a department of general internal medicine in a non-academic teaching hospital participated in this study. Data-analysis was informed by Billett's concept of guidance.

Results: Guidance on IPC was provided to medical trainees both intraprofessionally and interprofessionaly, be it limited, informal and implicit. Nurses and APCs provided more guidance on IPC than attending physicians. Guidance by attending physicians included implicit modelling and only became explicit in response to concerns raised about trainees' IPC by nurses. Nurses and APCs provided continuous guidance on various aspects of IPC but felt hampered by hierarchical issues to provide feedback. Trainees were more focused on feedback provided by attending physicians than they were aware of nurses' feedback.

Conclusion: The potential of workplace learning to learn IPC competencies is currently hampered by a lack of explicit guidance. Optimizing the role of workplace learning in IPC competence development requires more explicit role modelling and collaborative intentionality by attending physicians, more critical reflection by trainees and a strengthening of the feedback role of nurses and APCs.