Interprofessional Teams: Exposure to and Attitudes toward Three-Year Prospective Study of Longitudinal Integrated Clerkship vs. Rotation-Based Clerkship D. Myhre, W. Woloschuk, J. Pedersen CLIC 2013

Conflict disclosure information This study was approved by the University of Calgary Conjoint Health Research Ethics Board Alberta Health, a department of the Government of Alberta, funds this program

… the contemporary world of health care requires that doctors see themselves as only one voice in a societal conversation about health and health care, and that when they fail to see themselves as situated in this way, they are failing to understand the world they inhabit ” - Alan Cribb, 2000

Interprofessional education (IPE) Learning experiences where members (or students) from more than one health care profession learn with, from, and about each other in order to foster Interprofessional Collaboration (IPC) and subsequently improve patient care

IPE motivators Government policy Professional organizations Prevention of medical errors Opinion leaders Individual schools Circumstantial necessity TOP DOWN BOTTOM UP

In comparing LIC and RBC … What is the exposure to interprofessional teams (IPTs)? What is the impact on the attitude towards interprofessional teams (IPTs)? Is there a rural factor? The issue

Study objectives Compare exposure to IPT’s experienced by Longitudinal Integrated Clerkship (LIC) students to Family Medicine (FM) Rotation Based Clerkship (RBC) students in different community types Investigate change in attitude of clerks from both RBC and LIC streams towards IPT’s following clerkship rotations

Hypothesis Longer rotation duration with LIC program will lead to increased exposure to IPT’s and facilitate improved attitudinal changes compared to the shorter rotations offered by RBC Rural location will lead to increased exposure to IPT’s and facilitate improved attitudinal changes

6 week Fam Med block Primarily in Calgary with additional regional and rural streams Students not selected for LIC are placed in RBC 32 weeks integrated Student dyads placed in rural family practice Explicit IPT curriculum expectations FM clerkship streams LIC RBC

UCLIC communities

Methodology IPT Exposure defined as “two or more interactions with at least 3 different health care professionals to assess and/or treat a specific patient where all perspectives are considered/respected” Data were analyzed using descriptive statistics and inferential statistics IPE Attitudes were part of an overall pre-post rotation evaluation

Exploratory factor analysis Attitudes towards rotations were assessed using a 26 item survey Three of the 26 items correlated to IPTs (factor loading between 0.58 – 0.83) Relevant factor was identified as Attitude to IPTs (AIPTs) 1.IPTS are fundamental to comprehensive patient care in rural areas 2.In rural areas there is a close working relationship among all members of the health care team 3.An interprofessional team approach provides added value to patient care

Study group numbers Clerkship group (33)(34) (76) (152) (24) (46) (80) (208)

Exposure to IPTs Clerkship group % reporting >6 IPT interactions (76) (38) (25) (21)

Professional diversity of IPTs Mean number of different health professionals (7.8) (5.6) (3.5) (2.7) Clerkship group P=<0.05

Changes to AIPTs over time Time point Mean AIPT score

Discussion Large effect size of the post rotation AITPs between LIC and RBC students (d = 0.73) Rural significantly increased exposure (p=0.012) in RBC These findings may highlight: The impact of rural learning environments on IPT The importance of duration of experience on attitude change The effect of explicit exposure to IPTs as a component of undergraduate medical education

Limitations Low response rate by rotation based clerks compared to longitudinal integrated clerks 97% LIC response vs 44% RBC responses Small sample size of longitudinal integrated clerks Selection bias of LIC students Students have input regarding clerkship stream and location

Take homes LIC students had sig greater exposure to IPTs LIC students had exposure to more diverse IPTs LIC students showed a significant improvement in attitude towards IPTs Rural had sig > exposure to IPT in RBC Future studies should investigate AITP in relation to the duration of rotation and number of IPTs involved

Dr. D. Myhre Associate Dean Distributed Learning & Rural Initiatives (DLRI)