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All together now — learning from other medical disciplines
09 July 2015
Pictured L to R: Prof Liz Anderson, University of Leicester; Dr Frances Horgan, Vice Dean for
Interprofessional Education and Senior Lecturer, School of Physiotherapy, RCSI; guest speaker Prof
Maryellen Gusic, Association of American Medical Colleges; Prof Arnold Hill, Head of the RCSI
School of Medicine; guest speaker Dr Christin Ryan, Queen's University Belfast; and Ms Maree
Jensen, University of Auckland, New Zealand
CATHERINE REILLY REPORTS ON THE RECENT INTER-PROFESSIONAL EDUCATION
SYMPOSIUM AT THE RCSI IN DUBLIN
Bringing together medical and nursing students at RCSI Bahrain, under an inter-professional
education (IPE) initiative, was among the activities presented at a symposium on IPE at the
RCSI, Dublin, on 25 June.
The special symposium was part of the 4th annual International Education Forum, a weeklong initiative attended by 28 staff from RCSI Bahrain and PU-RCSI Malaysia, and more
than 130 colleagues in Dublin.
IPE is defined as “occasions when two or more healthcare professionals learn with, from,
and about each other in order to improve collaboration and the quality of care” (Centre for
Advancement of Inter-Professional Education, 2002).
The symposium was opened by Senior Lecturer in Physiotherapy Dr Frances Horgan, who
was appointed in September as the RCSI’s first Vice-Dean for IPE. With IPE of increasing
importance to regulators accrediting healthcare courses, the appointment is considered a
vital means of further advancing this area at the College.
The RCSI has also established a working group to support the work of the Vice-Dean. It is
comprised of Prof David Williams, Department of Medicine, RCSI/Beaumont Hospital; Dr
Judith Strawbridge, School of Pharmacy, RCSI; Dr Declan Patton, School of Nursing, RCSI;
and Ms Maeve Royston, RCSI Bahrain.
Activities in the RCSI undergraduate curricula and the perspectives of international speakers
on IPE’s challenges and benefits were also showcased at the symposium.
Bahrain
Lecturer at RCSI Bahrain, Ms Maeve Royston, conveyed a particularly unique experience
involving medical and nursing students at the College.
This pilot project emerged from parameters drawn-up by the Irish Medical Council as part of
the accreditation process for the medical undergraduate programme.
Ms Royston, whose clinical background is in midwifery, approached RCSI Professor of
Obstetrics and Gynaecology Prof Andrew Curtain about developing an IPE project. It was
decided to focus the pilot around obstetric emergencies and ‘near-misses’ that impact
women in pregnancy and childbirth, to include patient stories as to how they were affected
by conditions such as post-partum haemorrhage and pre-eclampsia.
Prof Andrew Curtain and Prof Frank Cunningham, RCSI Bahrain
Ms Royston said that, from a number of perspectives, this area is ripe for collaboration. She
noted that while obstetricians and midwives (or obstetric nurses, in the case of Bahrain)
have “very different jobs,”, maternal care is team-based.
“We also knew that maternal mortality rates in Bahrain were still quite high, but they are also
high worldwide and this is something that is really important,” she said. “There were plenty of
risk factors on the increase, with regard to challenging conditions in maternity care. And
also, it was a very rich area for ethics and professionalism.”
In Bahrain, Ireland and elsewhere, maternity care is sensitive to cultural and gender issues,
outlined Ms Royston. Nevertheless, factors particularly relevant to Bahrain and the wider
Middle East gave the project’s scope particular importance and relevance.
While there are challenges worldwide in respect to teaching obstetrics and maternity care, in
Bahrain these are pronounced, in that male nursing and medical students get less clinical
exposure in this specialty compared to their female colleagues (the male-to-female student
ratio is 60:40 in medicine and 15:85 in nursing), she elaborated.
Furthermore, there is no midwifery training programme in Bahrain, and fewer male doctors
are pursuing obstetrics as a career.
Ms Royston also noted that little is known about how families in the Middle East respond to
maternal or neonatal morbidities and mortality.
‘World Café’
It was decided to link nursing students in year three — when maternity nursing is taught —
with the medical students in senior cycle one. Teaching methods included ‘World Café
Conversations’, which brought medical and nursing students together in a relaxed setting
where contribution and conversation were encouraged.
Ms Royston said that, due to a number of social and cultural reasons, there had been very
little socialisation between the medical and nursing students, therefore this type of
methodology was helpful.
Other techniques included lectures, videos, small group discussions and clinical simulation.
The project took place over an afternoon and topics included an introduction to IPE, CPR in
pregnancy, managing post-partum haemorrhage, simulation of CPR, patient experiences
around maternal mortality (sourced from www.healthtalk.org) and ethical issues.
In Bahrain, Ireland and elsewhere, maternity care is sensitive to cultural and gender issues,
outlined Ms Royston
Learning outcomes for the nursing and medical students were demonstration of obstetric
emergency management; recognition of the impact of maternal mortality; consideration of
the patient’s viewpoint; and reflection on ethical, social and cultural challenges that surround
obstetric events, and on the impact of IPE on team-based care.
On the second occasion that the session was held, it was decided to involve nursing
students from year four. There had been a “language barrier” with regard to student nurses
in year three and some were “very shy”. In general, the nursing students in year four were
more confident and had better English. Overall, feedback from the sessions was positive,
with plenty of scope to further develop IPE, noted Ms Royston.
As one student observed, CPR for pregnant women was challenging and emphasised “the
importance of working as a team, dividing the work between us”.
Ireland
Currently at the RCSI in Dublin, there are a number of early-, middle- and late-stage IPE
activities across the programmes of medicine, physiotherapy and pharmacy.
Dr Muirne Spooner, Senior Clinical Tutor and Lecturer, RCSI, outlined a case-based
initiative on stroke introduced this year for Intermediate Cycle 3 medicine, Intermediate
Cycle B (third year) pharmacy students and selected physiotherapy students. It brought
together students in small groups with facilitators from the medical, pharmacy and
physiotherapy degree courses.
Tasks were designed so that there were interdependencies between the students, who
relied on each other for relevant clinical information.
The observation that healthcare professionals could not work in silos came across during the
students’ evaluations, which Dr Spooner noted as positive.
Mr Declan J Magee, President, RCSI; Prof Hannah McGee, Dean of the Faculty of Medicine and
Health Sciences, RCSI; and Dr Adrian Devitt, RCSI
Challenges in respect of implementing IPE, highlighted by a number of speakers, included
timetabling and the imbalance in numbers between medical, pharmacy and physiotherapy
students.
As noted by Dr Judith Strawbridge, Senior Lecturer at the RCSI School of Pharmacy, there
is pressure on curricula, everybody is busy and “there is so much to be taught”. However,
she said the creation of the Vice-Deanship will be helpful strategically, while there are many
“champions” eager to drive IPE forward.
Guest speaker Dr Maryellen Gusic, Chief Medical Education Officer at the Association of
American Medical Colleges, presented on ensuring competence in IPE and creating an
environment that promotes and supports learning. She also noted the increasing importance
of IPE in medical education and in the practice of medicine.
Opportunities
As Dr Gusic noted, the Liaison Committee on Medical Education (LCME), which accredits a
medical education programme leading to the MD degree in the US and Canada, stipulates
that the faculty of a medical school must ensure that medical students have opportunities to
learn in academic environments that permit interaction with students enrolled in other health
professions. These standards also state the faculty of a medical school must ensure that the
core curriculum of the medical education programme prepares medical students to function
collaboratively on healthcare teams.
During her presentation, Dr Gusic also referred to the work of the IPE Collaborative (IPEC),
formed in 2009 by associations of schools of the health professions. This organisation aims
to foster a common vision for team-based care; promote efforts to reform healthcare delivery
and financing consistent with that vision; and contribute to development of leaders and
resources for substantive inter-professional learning.
Speaking to the Medical Independent (MI) at the symposium, the RCSI’s Vice Dean for IPE
Dr Horgan said the College is fortunate in having a number of “champions” who had initiated
IPE activities over recent years. She said the College aimed to put in place more longitudinal
evaluations to assess the impact of IPE over time, and to further engage with staff and
students to identify the best means of incorporating IPE at undergraduate and postgraduate
levels.
As she had earlier outlined, IPE is a tool to accomplish linkages between the education
system and the healthcare delivery system; and to achieve better patient care, health
outcomes, and more efficient and affordable educational and healthcare systems.
Other speakers at the symposium were Dr Cristín Ryan of the School of Pharmacy, Queen’s
University Belfast; Prof Liz Anderson of the Department of Medical and Social Care
Education, University of Leicester, UK; and Ms Maree Jensen, Academic Director of the
School of Pharmacy University of Auckland, New Zealand.
Session chairs were Prof Hannah McGee, Dean, Faculty of Medicine and Health Sciences,
RCSI; Prof Arnold Hill, Head of the School of Medicine, RCSI; Prof Marie Guidon, Head of
the School of Physiotherapy, RCSI; and Prof Paul Gallagher, Head of the School of
Pharmacy, RCSI.