http://informahealthcare.com/jic ISSN: 1356-1820 (print), 1469-9567 (electronic) J Interprof Care, Early Online: 1–3 ! 2015 Informa UK Ltd. DOI: 10.3109/13561820.2015.1004040
SHORT REPORT
An interprofessional community education project as a socially accountable assessment
J Interprof Care Downloaded from informahealthcare.com by Nanyang Technological University on 04/28/15 For personal use only.
Peter Gallagher1, Sue Pullon2, Margot Skinner3, Patrick McHugh2, Eileen McKinlay2 and Lesley Gray2 1
Medical Education Unit, University of Otago – Wellington, Wellington, New Zealand, 2Primary Health Care and General Practice, University of Otago – Wellington, Wellington, New Zealand, and 3Department of Physiotherapy, University of Otago – Dunedin, Dunedin, New Zealand
Abstract
Keywords
As part of a clinically based rotational undergraduate interprofessional programme, an assessment was devised which was construed as being socially accountable. An interprofessional programme, with cohorts of students from six different health professions, was evaluated in a number of ways. Students completed pre and post questionnaires about many aspects of the programme and also participated in focus groups. The social accountability of the key assignment emerged as important for both students and the community agencies that provided the clinical experience for students. Students implicitly and explicitly reported that their awareness of the need for health professionals to be socially accountable was heightened as a result of the assignment task. This article indicates that with creativity and perseverance an assessment can be devised that is relevant both to the student and the community, and is a powerful learning exercise for all involved.
Assessment, community-based education, interprofessional education, social accountability undergraduate
Introduction Initiatives in interprofessional education (IPE) are encouraged to be socially accountable (Dugani & McGuire, 2011; JarvisSelinger et al., 2008). However, the concept of social accountability is in practice given little weight or value in curriculum design (Frenck et al., 2011). In the context of health professional education, Faculty have rarely sought to incorporate the concept of social accountability into student assessment strategies. However, this brief qualitative descriptive report of an interprofessional case study outlines how social accountability can become embedded as part of a summative assessment. In 2012, three New Zealand institutions combined to introduce a pilot interprofessional programme for final-year undergraduate students from six health professions: Medicine, Dentistry, Nursing, Physiotherapy, Pharmacy and Dietetics. The programme was based in a rural region on the East Coast of the North Island (Tairawhiti), the most economically deprived region also with the highest proportion (49%) of indigenous people (Maori) in New Zealand. In pursuit of outcomes for a rural, clinically based interprofessional programme (Pullon et al., in press) an assessment strategy was needed. That strategy presented some key educational challenges: the need to devise a practical way by which the key learning outcomes could be assessed; the importance of ensuring the specific assignment task was professionally neutral, so that no student was advantaged or disadvantaged simply because of the profession that they had chosen to enter; the requirement for
History Received 12 December 2013 Revised 19 October 2014 Accepted 31 December 2014 Published online 27 January 2015
each student to contribute equally and need for the process to be transparent; and the challenge to make sure that the assignment was not merely a hurdle to be negotiated but a meaningful exercise for the students. To this mix of challenges the teaching team recognised a further challenge, which was to ensure that the assignment task created had an appropriate cultural context and that the outcomes of the assignment would benefit the community that hosted the students; i.e. that the key assignment task would act as a central vehicle for social accountability. After much deliberation it was decided that the key assignment task would be a group project. The value of group work and associated presentations as an assessment method has been brought into question. Nonetheless, group projects produce clear benefits to team cohesion, peer learning and in-depth development of ideas (Nordberg, 2008). Furthermore, to complete the assignment students in this programme were obliged to work interprofessionally. The project task was for the students to devise a credible community education resource that could be of immediate benefit to the community as well as facilitate student learning. More importantly the topic for each project was generated by a community agency that had identified a clear need within their community.
Methods This qualitative study sought to explore how participants responded to IPE as an educational innovation. Data collection
Correspondence: Dr. Peter Gallagher, PhD, University of Otago – Wellington, Wellington, New Zealand. E-mail: peter.gallagher@ otago.ac.nz
Over the first 18 months of the programme one of the authors (P.G.) conducted seven separate interprofessional focus groups;
2
P. Gallagher et al.
one per 5-week rotation. Each group comprised 10–12 students from at least four and sometimes all of the following six professions; medicine, nursing, dentistry, physiotherapy, pharmacy and dietetics. All 75 students who engaged in the programme over18 months participated in end-of-rotation focus groups of 10–12 students each. PG also undertook individual interviews with those community providers who agreed to be interviewed (n ¼ 12). A template of specific questions was used during each focus group discussion with an open-ended question to allow students to elaborate on other aspects of interest. The focus group discussions were recorded and transcribed, and field notes were made during the individual interviews.
J Interprof Care Downloaded from informahealthcare.com by Nanyang Technological University on 04/28/15 For personal use only.
Data analysis Data were analysed using a modified grounded theory approach whereby data were coded and categorised until themes emerged (Strauss & Corbin, 1990). Some of the key themes that were relevant to the delivery of the entire programme were; the importance of learning in the work place, the impact of students living with and learning from each other, a realisation that health is a holistic concept and the influence of the quality of a positive learning ambiance for students. Ethical considerations Ethical approval for the study was granted by the University of Otago.
Results Each focus group comprised small numbers of students from each of the respective professions. There were usually three, two and sometimes only one from the participating professions. To heighten anonymity the recordings did not require that students identify themselves. Thus, no profession nor any individual student or staff participant can be identified. As stated earlier several themes emerged during the data analysis in relation to IPE; however, an unexpected theme and one not directly addressed by the group moderator was the students’ view that the community assessment was socially accountable. To illustrate how students and staff responded to the community project verbatim data from across the range of interviews are presented in Table I. Initially, some students were unclear as to the actual purpose of the assignment despite being given clear explanations which may reflect the developmental nature of an inaugural programme and the lack of clarity held by all sets of stakeholders. In later groups there was a greater understanding of what was required; however, the focus of the projects still puzzled some students. However as the focus group discussions progressed the students sensed that they were ‘‘working for real’’ on a project for the community. It was this feeling, one of undertaking a meaningful project that heightened the realisation that a socially accountable component to the programme had emerged; one that had not been predicted in the design phase. That the students were convinced of the value of their work to the community was a perspective also held by the community agencies: For one agency, the value of the student group project had a clear tangible impact in enhancing the actual service they provide. Another reported they incorporated a projects’ data into their submissions to secure external contracts and government funding.
Discussion The final years of health professional degrees in New Zealand are predominantly but not exclusively practice-based. For some
J Interprof Care, Early Online: 1–3
Table I. Participants’ perceptions of the project. I didn’t even understand what the project was. We tried so hard to figure out what they wanted us to do but it just didn’t make any sense (Student focus group February 2012 – M, N, De, Ph, Py) Doing the project . . . is fun, except that the topic of the project was completely irrelevant to our specialties. (Student focus group August 2013 – M, De, Ph, Py, Di) I think anything can be a really good topic but it’s like the stuff we did we kind of already knew anyway and I didn’t feel that we did a lot of learning from our project, so it was kind of just time-consuming. (Student focus group June 2013 – M, N, Ph, Py, Di) But I don’t see how either of our projects are really going to make a difference (Student focus group May 2013 – M, N, Ph, Py, Di) I think with us [because] we were actually doing it for real people who were actually going to implement our thing, like in the back of our mind . . . ‘‘Oh my goodness.’’ (Student focus group June 2013 – M, N, Ph, Py, Di) We had to make this good, because this is actually going to be used in two weeks’ time, and they’re going to be doing this programme. (Student focus group June 2013 – M, N, Ph, Py, Di) I liked that we were doing a real project. (Student focus group August 2013 – M, De, Ph, Py, Di) And if it’s giving back, then I think it’s great.(Student focus group February 2012 – M, N, De, Ph, Py) The presentation itself is a resource and their presence [referring to the students] has made an impression on us. (Clinical Provider interview August 2013) The composition of students from each profession in the focus groups is provided in the following: Medicine ¼ M, Nursing ¼ N, Dentistry ¼ De, Pharmacy ¼ Ph, Physiotherapy ¼ Py, Dietetics ¼ Di.
students the direct relevance of the projects, conceived by community agencies, to their prospective role as health professionals initially proved challenging. This study supports the notion that students participating in an IPE programme, in a rural location with a high indigenous population can successfully achieve their academic outcomes while also engaging in a socially accountable activity. Given the programme’s location in a small community with limited resources, social accountability in the sense of ‘‘giving something tangible back’’ to the community is key to engagement with the community and ultimately the sustainability of the programme. Similar to the experiences of others (e.g. Bridges, Davidson, Soule Odegard, Maki, & Tomkowiak, 2011; Oandasan & Reeves, 2005) this was an unanticipated finding; however, it is suggested that in future programmes, creative leaders take up the challenge to embed social accountability into other practical and theoretical aspects of the curriculum. The interprofessional project was the first of its kind in New Zealand and was well resourced. All staff were very positive about the programme and the location was carefully chosen. These factors may have meant that participants were positively disposed to aspects of the programme from the outset.
Acknowledgements The authors would like to acknowledge all of the students and staff who participated in the project and also acknowledge the collaboration between the University of Otago and the Eastern Institute of Technology.
Declaration of interest The project was funded by Health Workforce New Zealand. The authors report no conflicting interests. The authors were responsible for the writing and content of this article.
DOI: 10.3109/13561820.2015.1004040
References
J Interprof Care Downloaded from informahealthcare.com by Nanyang Technological University on 04/28/15 For personal use only.
Bridges, D.R., Davidson, R.A., Odegard, P.S., Maki, I.V., & Tomkowiak, J. (2011). Interprofessional collaboaration: Three best practice models of interprofessional education. Medical Education Online 2011;16. doi:10.3402/meo.v16i0.6035. Dugani, S., & McGuire, R. (2011). Development of IMAGINE: A threepillar student initiative to promote social accountability and interprofessional education. Journal of Interprofessional Health Care, 25, 454–456. Frenck, J., Chen, L., Bhutta, Z., Cohen, J., Crisp, N., Evans, T., Fineberg, H., et al. (2011). Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. Lancet, 376, 1923–1958. Jarvis-Selinger, S., Ho, K., Laucher, H.N., Liman, Y., Stacy, E., Woollard, R., & Buote, D. (2008). Social accountability in action: University-community collaboration in the development of an
Social accountability
3
inter professional Aboriginal health elective. Journal of Interprofessional Health Care, 22, 61–72. Nordberg, D. (2008). Group projects: More learning? Less fair? A conundrum in assessing postgraduate business education. Assessment and Evaluation in Higher Education, 33, 481–492. Oandasan, I., & Reeves, S. (2005). Key elements for interprofessional education. Part 1: The learner, the educator and the learning context. Journal of Interprofessional Care, 19, 21–38. Pullon, S., McKinlay, E., Gallagher, P., Gray, L., Skinner, M., & McHugh, P. (in press). Interprofessional education in a rural clinical setting: A quick start innovation for final year health professional students – Case study (Chapter 14). In Harden R. (Ed.), Handbook of medical education. London: Routledge. Strauss, A., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park: Sage Publications.
SHORT REPORT
An interprofessional community education project as a socially accountable assessment
J Interprof Care Downloaded from informahealthcare.com by Nanyang Technological University on 04/28/15 For personal use only.
Peter Gallagher1, Sue Pullon2, Margot Skinner3, Patrick McHugh2, Eileen McKinlay2 and Lesley Gray2 1
Medical Education Unit, University of Otago – Wellington, Wellington, New Zealand, 2Primary Health Care and General Practice, University of Otago – Wellington, Wellington, New Zealand, and 3Department of Physiotherapy, University of Otago – Dunedin, Dunedin, New Zealand
Abstract
Keywords
As part of a clinically based rotational undergraduate interprofessional programme, an assessment was devised which was construed as being socially accountable. An interprofessional programme, with cohorts of students from six different health professions, was evaluated in a number of ways. Students completed pre and post questionnaires about many aspects of the programme and also participated in focus groups. The social accountability of the key assignment emerged as important for both students and the community agencies that provided the clinical experience for students. Students implicitly and explicitly reported that their awareness of the need for health professionals to be socially accountable was heightened as a result of the assignment task. This article indicates that with creativity and perseverance an assessment can be devised that is relevant both to the student and the community, and is a powerful learning exercise for all involved.
Assessment, community-based education, interprofessional education, social accountability undergraduate
Introduction Initiatives in interprofessional education (IPE) are encouraged to be socially accountable (Dugani & McGuire, 2011; JarvisSelinger et al., 2008). However, the concept of social accountability is in practice given little weight or value in curriculum design (Frenck et al., 2011). In the context of health professional education, Faculty have rarely sought to incorporate the concept of social accountability into student assessment strategies. However, this brief qualitative descriptive report of an interprofessional case study outlines how social accountability can become embedded as part of a summative assessment. In 2012, three New Zealand institutions combined to introduce a pilot interprofessional programme for final-year undergraduate students from six health professions: Medicine, Dentistry, Nursing, Physiotherapy, Pharmacy and Dietetics. The programme was based in a rural region on the East Coast of the North Island (Tairawhiti), the most economically deprived region also with the highest proportion (49%) of indigenous people (Maori) in New Zealand. In pursuit of outcomes for a rural, clinically based interprofessional programme (Pullon et al., in press) an assessment strategy was needed. That strategy presented some key educational challenges: the need to devise a practical way by which the key learning outcomes could be assessed; the importance of ensuring the specific assignment task was professionally neutral, so that no student was advantaged or disadvantaged simply because of the profession that they had chosen to enter; the requirement for
History Received 12 December 2013 Revised 19 October 2014 Accepted 31 December 2014 Published online 27 January 2015
each student to contribute equally and need for the process to be transparent; and the challenge to make sure that the assignment was not merely a hurdle to be negotiated but a meaningful exercise for the students. To this mix of challenges the teaching team recognised a further challenge, which was to ensure that the assignment task created had an appropriate cultural context and that the outcomes of the assignment would benefit the community that hosted the students; i.e. that the key assignment task would act as a central vehicle for social accountability. After much deliberation it was decided that the key assignment task would be a group project. The value of group work and associated presentations as an assessment method has been brought into question. Nonetheless, group projects produce clear benefits to team cohesion, peer learning and in-depth development of ideas (Nordberg, 2008). Furthermore, to complete the assignment students in this programme were obliged to work interprofessionally. The project task was for the students to devise a credible community education resource that could be of immediate benefit to the community as well as facilitate student learning. More importantly the topic for each project was generated by a community agency that had identified a clear need within their community.
Methods This qualitative study sought to explore how participants responded to IPE as an educational innovation. Data collection
Correspondence: Dr. Peter Gallagher, PhD, University of Otago – Wellington, Wellington, New Zealand. E-mail: peter.gallagher@ otago.ac.nz
Over the first 18 months of the programme one of the authors (P.G.) conducted seven separate interprofessional focus groups;
2
P. Gallagher et al.
one per 5-week rotation. Each group comprised 10–12 students from at least four and sometimes all of the following six professions; medicine, nursing, dentistry, physiotherapy, pharmacy and dietetics. All 75 students who engaged in the programme over18 months participated in end-of-rotation focus groups of 10–12 students each. PG also undertook individual interviews with those community providers who agreed to be interviewed (n ¼ 12). A template of specific questions was used during each focus group discussion with an open-ended question to allow students to elaborate on other aspects of interest. The focus group discussions were recorded and transcribed, and field notes were made during the individual interviews.
J Interprof Care Downloaded from informahealthcare.com by Nanyang Technological University on 04/28/15 For personal use only.
Data analysis Data were analysed using a modified grounded theory approach whereby data were coded and categorised until themes emerged (Strauss & Corbin, 1990). Some of the key themes that were relevant to the delivery of the entire programme were; the importance of learning in the work place, the impact of students living with and learning from each other, a realisation that health is a holistic concept and the influence of the quality of a positive learning ambiance for students. Ethical considerations Ethical approval for the study was granted by the University of Otago.
Results Each focus group comprised small numbers of students from each of the respective professions. There were usually three, two and sometimes only one from the participating professions. To heighten anonymity the recordings did not require that students identify themselves. Thus, no profession nor any individual student or staff participant can be identified. As stated earlier several themes emerged during the data analysis in relation to IPE; however, an unexpected theme and one not directly addressed by the group moderator was the students’ view that the community assessment was socially accountable. To illustrate how students and staff responded to the community project verbatim data from across the range of interviews are presented in Table I. Initially, some students were unclear as to the actual purpose of the assignment despite being given clear explanations which may reflect the developmental nature of an inaugural programme and the lack of clarity held by all sets of stakeholders. In later groups there was a greater understanding of what was required; however, the focus of the projects still puzzled some students. However as the focus group discussions progressed the students sensed that they were ‘‘working for real’’ on a project for the community. It was this feeling, one of undertaking a meaningful project that heightened the realisation that a socially accountable component to the programme had emerged; one that had not been predicted in the design phase. That the students were convinced of the value of their work to the community was a perspective also held by the community agencies: For one agency, the value of the student group project had a clear tangible impact in enhancing the actual service they provide. Another reported they incorporated a projects’ data into their submissions to secure external contracts and government funding.
Discussion The final years of health professional degrees in New Zealand are predominantly but not exclusively practice-based. For some
J Interprof Care, Early Online: 1–3
Table I. Participants’ perceptions of the project. I didn’t even understand what the project was. We tried so hard to figure out what they wanted us to do but it just didn’t make any sense (Student focus group February 2012 – M, N, De, Ph, Py) Doing the project . . . is fun, except that the topic of the project was completely irrelevant to our specialties. (Student focus group August 2013 – M, De, Ph, Py, Di) I think anything can be a really good topic but it’s like the stuff we did we kind of already knew anyway and I didn’t feel that we did a lot of learning from our project, so it was kind of just time-consuming. (Student focus group June 2013 – M, N, Ph, Py, Di) But I don’t see how either of our projects are really going to make a difference (Student focus group May 2013 – M, N, Ph, Py, Di) I think with us [because] we were actually doing it for real people who were actually going to implement our thing, like in the back of our mind . . . ‘‘Oh my goodness.’’ (Student focus group June 2013 – M, N, Ph, Py, Di) We had to make this good, because this is actually going to be used in two weeks’ time, and they’re going to be doing this programme. (Student focus group June 2013 – M, N, Ph, Py, Di) I liked that we were doing a real project. (Student focus group August 2013 – M, De, Ph, Py, Di) And if it’s giving back, then I think it’s great.(Student focus group February 2012 – M, N, De, Ph, Py) The presentation itself is a resource and their presence [referring to the students] has made an impression on us. (Clinical Provider interview August 2013) The composition of students from each profession in the focus groups is provided in the following: Medicine ¼ M, Nursing ¼ N, Dentistry ¼ De, Pharmacy ¼ Ph, Physiotherapy ¼ Py, Dietetics ¼ Di.
students the direct relevance of the projects, conceived by community agencies, to their prospective role as health professionals initially proved challenging. This study supports the notion that students participating in an IPE programme, in a rural location with a high indigenous population can successfully achieve their academic outcomes while also engaging in a socially accountable activity. Given the programme’s location in a small community with limited resources, social accountability in the sense of ‘‘giving something tangible back’’ to the community is key to engagement with the community and ultimately the sustainability of the programme. Similar to the experiences of others (e.g. Bridges, Davidson, Soule Odegard, Maki, & Tomkowiak, 2011; Oandasan & Reeves, 2005) this was an unanticipated finding; however, it is suggested that in future programmes, creative leaders take up the challenge to embed social accountability into other practical and theoretical aspects of the curriculum. The interprofessional project was the first of its kind in New Zealand and was well resourced. All staff were very positive about the programme and the location was carefully chosen. These factors may have meant that participants were positively disposed to aspects of the programme from the outset.
Acknowledgements The authors would like to acknowledge all of the students and staff who participated in the project and also acknowledge the collaboration between the University of Otago and the Eastern Institute of Technology.
Declaration of interest The project was funded by Health Workforce New Zealand. The authors report no conflicting interests. The authors were responsible for the writing and content of this article.
DOI: 10.3109/13561820.2015.1004040
References
J Interprof Care Downloaded from informahealthcare.com by Nanyang Technological University on 04/28/15 For personal use only.
Bridges, D.R., Davidson, R.A., Odegard, P.S., Maki, I.V., & Tomkowiak, J. (2011). Interprofessional collaboaration: Three best practice models of interprofessional education. Medical Education Online 2011;16. doi:10.3402/meo.v16i0.6035. Dugani, S., & McGuire, R. (2011). Development of IMAGINE: A threepillar student initiative to promote social accountability and interprofessional education. Journal of Interprofessional Health Care, 25, 454–456. Frenck, J., Chen, L., Bhutta, Z., Cohen, J., Crisp, N., Evans, T., Fineberg, H., et al. (2011). Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. Lancet, 376, 1923–1958. Jarvis-Selinger, S., Ho, K., Laucher, H.N., Liman, Y., Stacy, E., Woollard, R., & Buote, D. (2008). Social accountability in action: University-community collaboration in the development of an
Social accountability
3
inter professional Aboriginal health elective. Journal of Interprofessional Health Care, 22, 61–72. Nordberg, D. (2008). Group projects: More learning? Less fair? A conundrum in assessing postgraduate business education. Assessment and Evaluation in Higher Education, 33, 481–492. Oandasan, I., & Reeves, S. (2005). Key elements for interprofessional education. Part 1: The learner, the educator and the learning context. Journal of Interprofessional Care, 19, 21–38. Pullon, S., McKinlay, E., Gallagher, P., Gray, L., Skinner, M., & McHugh, P. (in press). Interprofessional education in a rural clinical setting: A quick start innovation for final year health professional students – Case study (Chapter 14). In Harden R. (Ed.), Handbook of medical education. London: Routledge. Strauss, A., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park: Sage Publications.
