Learning to Work Together Interprofessionally – Interaction, Knowledge Construction, and Informal Learning in Clinical Education

Abstract

Delivering high-quality healthcare requires interprofessional collaboration and shared understanding of patient care goals. However, few health professions education programs are designed with consideration of the interactive knowledge building processes underpinning collaborative decision-making and effective teamwork. To better equip educators to design and evaluate interventions that support interprofessional learning, we conducted five studies related to knowledge construction (KC) in interprofessional interactions. We asked: How are shared mental models (SMMs) conceptualized, developed, and measured in clinical education? Can a KC model – the Interaction Analysis Model (IAM)– be used to characterize KC behaviors in different interprofessional contexts? Can an observational tool to assess interactive KC during interprofessional interactions be developed? How do interprofessional interactions support KC and informal clinical workplace learning? Methods: Our research – grounded in complimentary theoretical perspectives, including social constructivism, socio-culturalism, and organizational psychology – began with a scoping review to explore the SMM construct in the context of health professions education. We next developed an asynchronous learning module focused on medication management, using the IAM to design KC-supportive dialogue prompts. Randomized pharmacy-medicine learner pairs received either high- or low-KC guidance prompts. We analyzed dialogue using directed content analysis and evaluated prompt impact on learners’ KC behaviors and care plan quality. For study three, we developed a simplified IAM framework then determined feasibility and utility by applying it to transcripts of care planning discussions regarding nursing home patients. Next, we developed and collected validity evidence for an IAM-based observational tool to support formative assessment of KC behaviors. Lastly, we administered an international, cross-sectional, online survey to medical residents at three institutions to explore how interactions with pharmacists support residents’ KC and informal clinical workplace learning. Results: We found that the SMM construct was ill-defined and educational interventions to support SMMs and attempts to measure the construct were rare. This led us to define SMMs in clinical practice and select interactive KC as a better construct to guide and analyze interprofessional collaboration. We demonstrated that a simplified IAM could be used to analyze and assess the quality of interprofessional interactions, but the labor-intensive nature of the analyses led us to recommend development of an IAM-based observational tool. Tool evaluation yielded validity evidence indicating inter-rater reliability and congruence with expert ratings as well as support for its use in practice. Our survey revealed that interactions with pharmacists supported residents’ KC through a variety of mechanisms. Informal, workplace-based interactions with pharmacists – common in the US, infrequent in the Netherlands – overwhelmingly determined residents’ sense and appreciation of interprofessional learning. Discussion and conclusions: Our research advances understanding of how to design and evaluate interventions to better support the interactive KC processes required for interprofessional collaboration in practice. We demonstrated the utility of the simplified IAM for support and analysis of learners’ KC behaviors, designed an IAM-based tool to give learners formative feedback on their interprofessional interactions, and demonstrated the importance of interprofessional interaction in informal clinical workplace learning. This work establishes the utility of the KC construct in interprofessional clinical education.