Realist approach to evaluating an interprofessional education program for medical students in clinical practice at a community hospital

Abstract

Introduction: We examined the interrelationships between context, mechanism, and outcome using a realist approach following the introduction of interprofessional education (IPE) to clinical practice for medical students in the community. Methods: Through participant observation and interviews, a working hypothesis was developed. To evaluate IPE in clinical practice, medical students' reports were thematically analyzed, and configuration on contexts, mechanisms, and outcomes were identified using a realist approach. Results: Influential contexts were medical students' experience of clinical practice and learning characteristics, the capacity of other professionals, interprofessional relationships, and characteristics of the community hospital. One key mechanism was observational learning. Others were self-regulated learning, legitimate peripheral participation, experiential learning, contact hypotheses, awareness of social structure, and cognitive empathy. As faculties supported these key mechanisms, medical students became aware of the legitimacy of community-oriented primary care, noting the roles of physicians who support patients' and/or their family's life in collaboration with other professionals, and reflecting the necessity of shifting from physician-centered perspectives. As a result, medical students deepened their empathic understanding for other professionals. Conclusion: Faculties should develop IPE programs in clinical practice based on the 'mechanism', 'context', 'outcome' pattern and 'context-mechanism-outcome' configuration in primary care settings.

<p>Stimulating Students’ Interprofessional Teamwork Skills Through Community-Based Education: A Mixed Methods Evaluation</p>

“…25,26 Moreover, CBIPE helps stimulate social accountability in health profession students. 27 Various approaches to CBIPE have been previously reported such as learning in rural and primary healthcare settings, 24,28,29 community-based learning within broader community context 16,22,30 and for specific community context; the commonly used model of CBIPE in the western countries. 21,[31][32][33][34][35] The nature of interprofessional learning activities is mainly to provide healthcare services primary healthcare setting, not in the community.…”

The Perception of Rural Medical Students Regarding the Future of General Medicine: A Thematic Analysis

“…The participants strongly emphasized that current general medicine education at universities is poor and insufficient. Japan and other countries have reported that students can learn more regarding primary care and multiprofessional cooperation in community hospital training; furthermore, they primarily learn concerning rare diseases (by organ) during university training [26,27]. The effectiveness of community-based general medicine education has been demonstrated [28][29][30].…”

Exploiting Multidisciplinary Conferences in Radiology: Teaching and Learning Opportunities for Medical Students, Radiologists and Clinicians

“…Tasks should always be adequate for MC settings and non-interrruptive. Students should develop communicative skills in radiology (Slanetz, 2011;Rahim & Ros, 2016), and for future clinical practice in all medical disciplines (Gunderman et al, 2003;ESR, 2017;Haruta & Yamamoto, 2020). Such self-organised and responsible learning will prepare medical students completing their electives for future clinical practice within and outside of radiology (Schüßler, 2012;Arnold, 2015).…”

“…This way students would actively contribute to educational goals of MCs (O'Brien et al, 2017;Goulao, 2020). Moreover, students get to train communicative skills in medical contexts evolving around diagnostic and therapeutic decisions (Gunderman et al, 2003;Rahim & Ros, 2016;ESR, 2017;Haruta & Yamamoto, 2020) − skills imperative for their upcoming residency. Instead of expecting medical doctors to deliver on additional teaching when deciding on patient diagnoses and therapies, students can be involved in multidisciplinary communication and interaction.…”