http://informahealthcare.com/jic ISSN: 1356-1820 (print), 1469-9567 (electronic) J Interprof Care, 2015; 29(5): 426–432 ! 2015 Taylor & Francis Group, LLC. DOI: 10.3109/13561820.2015.1016602

ORIGINAL ARTICLE

Interprofessional team meetings: Opportunities for informal interprofessional learning Gillian Nisbet1, Stewart Dunn2, and Michelle Lincoln1 1

Faculty of Health Sciences, The University of Sydney, Lidcombe, Sydney, Australia and 2Sydney Medical School, The University of Sydney, St. Leonards, Sydney, Australia Abstract

Keywords

This study explores the potential for workplace interprofessional learning, specifically the learning that occurs between health professionals as part of their attendance at their regular interprofessional team meetings. While most interprofessional learning research to date has focused on formal structured education programs, this study adds to our understanding of the complexities of the learning processes occurring between health professionals as part of everyday practice. Through observations of team meetings and semi-structured interviews, we found that the interprofessional team meeting provided a practical, time-efficient, and relevant means for interprofessional learning, resulting in perceived benefits to individuals, teams, and patients. The learning process, however, was influenced by members’ conceptions of learning, participation within the meeting, and medical presence. This study provides a basis for further research to assist health professionals capitalize on informal learning opportunities within the interprofessional meeting.

Collective learning, interprofessional learning, interviews, qualitative method, work-based learning

Introduction Within the acute care setting there is a greater focus on health professionals working together (Kohn, Corrigan, & Donaldson, 2000; O’Leary, Sehgal, Terrell, & Williams, 2012), often within teams to ensure communication, cooperation and coordination between all the health professionals involved in patient care (Manser, 2009; Tattersall, 2006). Central to working together is the notion of learning together. Hence, the growing interest in interprofessional learning (IPL). While research to date has generally focused on more formal structured interprofessional education (IPE), this current study aimed to explore the informal IPL opportunities afforded by the workplace for health professionals. Informal learning encompasses the unstructured, experiential and non-institutional learning that occurs through everyday work practice (Billett, 2006; Marsick & Volpe, 1999). Swanwick (2005) advocates the role of informal learning in postgraduate medical education, particularly emphasizing sociocultural influences. Informal workplace learning can assist in the development of health professional’s expertise (Cole, 2004) and may have a legitimate role in service delivery and patient care improvement within primary care (Bunniss & Kelly, 2008). Nisbet, Lincoln, and Dunn (2013) argue that informal IPL opportunities are currently unrealized and under-utilized. Within the acute care setting, the interprofessional team (IPT) meeting is one context that provides opportunities for informal workplace IPL and is the focus of this study. Few studies have

Correspondence: Gillian Nisbet, Faculty of Health Sciences, The University of Sydney, Building J, Cumberland Campus, 75 East St., Lidcombe 2141, Sydney, Australia. E-mail: [email protected]

History Received 24 October 2013 Revised 5 December 2014 Accepted 4 February 2015 Published online 15 May 2015

focused on IPL within this context. Studies to date have focused on specific aspects of the meeting, for example, information flow (Demiris, Washington, Parker Oliver, & Wittenberg-Lyles, 2008), meeting facilitation to improve medication prescribing (Schmidt, Claesson, Westerholm, Nilsson, & Svarstad, 1998), decision making (Lanceley, Savage, Menon, & Jacobs, 2008), communication (Bokhour, 2006; Wittenberg-Lyles, Parker Oliver, Demiris, & Regehr, 2009), aspects of interaction (Arber, 2008; Bell, 2001), collaborative practice (e.g. Reeves et al., 2009; Suter et al., 2009) and teleconferencing (Kane & Luz, 2006) with limited exploration of learning. Aston, Shi, Bullot, Galway, and Crisp (2005) identified learning from others as a key benefit of daily meetings between nurses and doctors. While all these studies shed light on team meeting processes, they do not adopt a learning frame of reference. Nisbet et al. (2013) outline six reasons for a greater focus on learning within the workplace: learning for (i) innovation; (ii) practice improvement; (iii) improvement in performance; (iv) patient safety; (v) working together and (vi) for better patient outcomes. This current research, therefore deliberately focused on the learning aspect of IPT meetings. Guiding this research are sociocultural theories of learning which view learning as occurring within the individual and across individuals within the community (Mann, 2004). Learning is seen as a process that involves thinking, understanding and reasoning as well as developing beliefs, values, attitudes, assumptions and interpersonal skills (Rushmer & Davies, 2004). Learning is contextual—we shape and are shaped by the environment and our interactions within that environment (Hager, 2008). Learning is also a social participatory process where knowledge is created through everyday interactions (Elmholdt, 2004). Accordingly, this study aimed to investigate the potential for informal workplace IPL within this context.

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Methods This study adopted a qualitative interpretive approach, a methodology which is concerned with ‘‘. . . (i) how people interpret their experiences, (ii) how they construct their worlds and (iii) what meaning they attribute to their experiences’’. (Merriam, 2002, p. 38). It sought to better understand the phenomenon of IPL within the context of the IPT meeting through exploring the perspectives and experiences of those involved in the meetings. Research setting We conducted this study within a 600-bed, tertiary-referral teaching hospital located on the east coast of Australia. The setting was inpatient and outpatient IPT meetings. Recruitment We used purposeful sampling (Cohen, Manion, & Morrison, 2005) to identify teams for this study. We recruited health care teams that focused primarily on one clinical specialty (to remove the influence of multiple medical specialties within the meeting); included professionals from medicine, nursing and at least one other profession; held a formal timetabled team meeting at least monthly to discuss patient care and where attendance was mandatory. In total, 15 inpatient and 17 outpatient IPT meetings were identified. From this list, we randomly assigned inpatient and outpatient IPTs a ranking for ‘‘order to approach’’ to participate in the study. We contacted clinical specialty department heads and nursing unit managers of teams at the top of the ‘‘order to approach’’ to seek their support for the study. All but two teams approached took part in the study. Ethics approval was granted for each team. Participants completed individual written consent forms. In total, over a 6-month period four inpatient and two outpatient teams agreed to take part in the study, at which point no new themes emerged during analysis, thus, we considered that data saturation had been achieved. All team members agreed to participate in the observational component of the study. A minority were unavailable to complete the interview component. Owing to the size of Team C, it was not feasible to interview all members. However, we did not consider this detrimental to the study because those participants interviewed covered a range of professions. Data collection The first component of the study involved one author attending and observing each IPT meeting on three occasions to gain a shared context with study participants to inform the interview (as described later). We adopted an ‘‘observer as participant’’ approach whereby the observer’s purpose and activities at the meeting were known to all the team members (Neutens & Rubinson, 2002). The observer had an independent relationship with the team and its members. All meetings were digitally recorded and field notes taken. Pertinent observations, for example, teaching and learning opportunities, were highlighted for potential prompts in the interviews. In total, we observed 12 h of team meetings across the six teams. Team size varied, as indicated by average attendance at the observed team meetings (Table I)—smaller teams averaged seven team members per meeting whereas the largest team averaged 19 members. The second component of the study involved digitally recorded semi-structured interviews with study participants. Interviews were conducted following an interview guide developed from the literature, research aims and observations. It included demographic information; an exploration of perceived learning currently occurring within the team meeting and its impact on work

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practice; how the learning occurs; influences on the learning process and the value health professionals place on learning in this context. We piloted interview questions with three health professionals not associated with teams included in the study. Most interviews were face-to-face and within 1 month of the final observation; three interviews were by telephone. After each interview notes were written documenting relevant reflections on the interview content and process. In total, we conducted 77 interviews (average length 34 min; range 16–60 min). Professions interviewed were representative of those attending the team meeting (Table I). Interviews were transcribed verbatim for entry into NVivo software package (QSR N7, Melbourne, Australia) for analysis. Data analysis We followed an inductive thematic approach as described by Braun and Clarke (2006) to analyze interviews. After checking for transcription accuracy, the first author read and reread the transcripts several times noting down initial ideas. Transcripts were then segmented into meaning units and assigned an initial code. Codes with similar meaning units were grouped together into potential themes. This was an iterative process and involved analyzing data at individual and team levels, re-visiting previously coded data then comparing across teams to take into account the entire interview dataset. Groupings were checked and further refined by second and third authors to generate clear distinguishable themes. Theme names were generated by all the authors based on the content groupings. We sent a summary of the results of the thematic analysis at the team level to individual participants, highlighting findings relevant to their team and asking them to verify our themes. Feedback received from participants indicated agreement with the findings.

Findings Interview findings centred on four key themes: varying conceptions of learning; the IPT as a source of knowledge; learning through participation and medical influence on learning. Observational findings were primarily used to inform the interviews and enable a shared context with participants so they are not reported in this article. Varying conceptions of learning Conceptions of learning were forthcoming in the data illustrated by the ways participants described the team meeting as a learning opportunity. As the examples below indicate: I wouldn’t say specifically we’re here for the purpose of learning. It’s more a necessity really for everyone to be able to do their job. (Pharmacist, Team A) I can see where they’re coming from, they can see what I can deliver, we mutually learn. (Doctor, Team C) I think journal clubs and reading journals and attending conferences, that’s where you learn. (Dietician, Team B) For most participants, experiences of learning within the team meeting were related to functional/practical aspects specific to the patients being discussed. This learning occurred through observing others, listening and asking questions directly related to patient care, and participating in discussion. It was seen as a part of the job, often a sub-conscious element and integrated with providing optimal patient care. For others, learning was an explicit component of their attendance at the meeting resulting in improved job satisfaction and directly impacting on patient care. For a minority of participants, there appeared to be a clear

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Table I. Study sample.

Setting Average attendance at observed team meetings No. of interviews Non-interview participants Interviews Medicine Nursing Counsellor Dietetics MDT coordinator Occupational therapy Pharmacy Physiotherapy Psychology Social work

Team A Inpatient

Team B Inpatient

Team C Outpatient

Team D Inpatient

Team E Outpatient

Team F Inpatient

Total Six teams

17 17 2a

13 14 Nil

19 21 2a 3 not contacted

7 9 Nil

7 10 Nil

7 6 1a

– 77 8

8 4

5 5

11 3 3

3 3

1 6 1

1 1

1

1

29 22 4 3 1 4 2 4 2 5

1 1

1 1 1 1

1

1

1 1

1 1

1 1 1

1 1

1

1

a

Unavailable for interview.

division between learning and working. Learning was viewed as occurring through more formal education sessions. For a few participants (mainly doctors), learning within the meeting was considered integral to practice improvement. Not only was it a time-efficient way to keep up to date with academic knowledge across professions, but also an opportunity to seek opinions and feedback from others. This learning was considered as a part of the peer review and quality process and enabled the team to question and reflects on ‘‘are you managing the patient in the best way possible?’’ (Doctor, Team A). When comparing teams, one team (Team C) stood out— learning was conceptualized as a deliberate and named component of the meeting. Here, learning was explicitly built into the structure and terms of reference for the meeting. Learning was mainly described in terms of academic learning and occurred through integration of learning into patient-specific discussion: Someone may say ‘‘it should be so and so’’ and someone may say ‘‘why is that?’’ And you’d say ‘‘well I read this journal article last week’’ etc. Or someone may say ‘‘oh, there’s such and such’’ and you might say ‘‘well can you explain how it is, what the mechanism of action is?’’ or something like that. (Doctor, Team C) Thus, the experiences described above highlight the varying conceptions of learning participants held in relation to the IPT meeting. The interprofessional team as a source of knowledge The team meeting as a source of knowledge emerged through the ways participants described their experiences of learning and working within the meeting. Participants spoke of gaining insights into an individual’s professional practice—their capabilities, approach to patient care and decision-making, scope of practice within the team and practical tips for managing certain patient situations. As one participant explained: . . . you learn better people’s roles and their expertise. . . . You understand the frame of reference that people come from and the basis for their decision making. (Physiotherapist, Team F) Participants perceived this knowledge more practically to improve work efficiencies, for example, through being ‘‘more attuned to everyone’s work style and what they preferred, their

practice’’ (Doctor, Team B); having a greater awareness and integration of how the various professional roles ‘‘complemented each other’’ (Social worker, Team B) and removing duplication in service delivery. Participants described experiences whereby more academic or theoretical knowledge was shared, for example, information on a drug trial or a recently attended conference: You know it might be a new thing that they’re doing or a trial that they’re doing that they’re talking about. (Nurse, Team D) This was most noticeable in team meetings where more than one senior medical staff member attended. This academic knowledge helped participants stay up-to-date and broadened their knowledge base within their clinical area. In turn, this added to work enjoyment and interest. For some, it directly impacted on their practice through increasing confidence in their ability to provide accurate information to the patient as well as establishing trust between the patient and health professional: It’s (clinical trial) discussed in a meeting. . . . I had a patient from the (hospital) last week who came here who said she was on the (drug) trial, so I was then able to talk with her about that. (Nurse, Team C) Common across all teams was an awareness of the role of the meeting in developing skills in interprofessional communication. This was seen as somewhat different to communicating with one’s own profession owing to differences in jargon and terminology and the need to be succinct, due partly to a perception of lack of interest by others in the finer profession-specific details: So you learn to sort of talk a bit more differently. . . . One of the registrars here was a bit more uhm, they were still nice people but she was just really to the point so I had to change my way of talking so that I was talking a bit, less explanation and more sort of what my plan was exactly. (Dietician, Team A) Participants new to teams spoke of the team meeting as valuable for gaining knowledge around the general operations and functioning of the ward/hospital. This included knowledge about ward processes, discharge planning and services available on discharge as indicated by the following quote: We talk about the services that are out there, the services that are available. You know, occasionally I’ll hear something from

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the physio or OT and I’ll think, ‘‘oh, I didn’t realise that.’’ (Doctor, Team F)

Individual team members’ level of confidence and experience influenced their capacity to participate in the meeting:

Despite concerns voiced by participants about dysfunctional aspects of their team meeting, these issues were rarely discussed openly within the meeting or in any other forum. Participants described gaining insights into how to relate to others within the team. The team meeting helped build rapport and ‘‘get to know each other better’’ (Social welfare worker, Team 5F). For some participants, this interpersonal knowledge became particularly important when referring patients to other health professionals in the team. As one participant put it:

To be brave enough to do that (speak up) because you know, it can be intimidating. (Psychologist, Team C)

You get to understand the person behind, you sort of get to understand their personality or the way they think in a way about, you know, what they’re going to do for this patient and the different things that they say about them in a meeting. (Counselor, Team C)

I think because I am such a new grad . . . they could just shut me down or you know, that kind of, ‘‘What are you talking about? What do you know, you’re only a new grad.’’ (Dietitian, Team F) A strong influence on participation was the team meeting environment. When team members felt themselves as a part of the team, when there was role modelling of participation by all, where leadership encouraged input from all and where there was a will and desire to learn, participation was felt to be positively influenced. These learning behaviours encouraged learning within the meeting: She’s a good model in a sense because we all don’t hesitate in asking questions when we don’t understand things. (Psychologist, Team E)

Through attending the team meeting, participants gained greater insight into their own attributes and how these manifest themselves within the meeting. For example, one participant spoke of how the team meeting had helped develop his ‘‘confidence in being able to make decisions . . . that you can make safe, sensible and intuitive decisions about patient care’’ (Doctor, Team A). Another recognized his limitation of dominating the meeting. Others identified areas for self improvement, for example, developing confidence in speaking up and voicing an opinion. Whilst the IPT meeting provided diverse knowledge for participants, the perceived source and value of this knowledge varied across professions. Doctors were perceived by other health professionals to provide a valuable academic knowledge input, such as the latest research on a particular condition. Nursing staff were perceived by many medical staff to hold valuable practical insights into the patient’s immediate condition. Physiotherapists, social workers and occupational therapists often held valuable information on discharge processes and services available. However, there appeared to be a de-valuing by the non-doctor participants of their knowledge, particularly the practical insights that they could add to the meeting, and hence a reluctance to share this information:

Apparent from data analysis was the importance of the faceto-face contact. Participants spoke of increasing familiarity with team members positively influencing referrals, promoting communication outside of the meeting and increasing confidence to contact, seek advice or question team members from another profession. This latter finding is particularly pertinent for patient safety, suggesting that the team meeting has a broader scope of influence on patient safety beyond direct patient information exchange:

I just try and keep it short and snappy . . . I don’t say a lot about what the home situation is . . . or the dilemmas in terms of OT, you know, there’s just not enough airtime to say that. (Occupational therapist, Team B)

I’ve learned that, if I want things to change . . . that I need to actually, I need to be instigating that as well. So if I want people to speak up, I need to speak up. (Nurse, Team A)

So they give feedback that might make a difference to the treatment next time to the client. . . . The specialists are open to those types of constructive criticism, even if it isn’t all positive. (Counselor, Team C)

If I see them at the meeting, I’m more likely to be consulting with them about the patient and you’re talking about it, just all the time when you see them. (Nurse, Team D) A few participants highlighted the responsibility that they themselves had to participate in the meeting and role model that behaviour:

Medical influence on learning Participants believed knowledge developed within the team meeting had direct impact and benefits to patients. This included receiving more holistic and comprehensive care; access to appropriate resources and services through greater awareness of what is available and clearer informed answers to questions and explanation of concepts because health professionals had a wider academic knowledge base and greater understanding of roles and work practices of fellow team members. Learning through participation A strong theme to emerge from the data was the notion of learning through actively participating and interacting with others within the IPT meeting. It was through whole team discussion and voicing different perspectives, asking questions and raising concerns that learning was enriched. However, a range of factors were identified that influenced participation.

The fourth theme identified from the data was the strong influence of medical staff on learning within the IPT meeting. This influence was seen as both positive and negative. Sharing of academic knowledge was generally initiated by medical staff. Other health professionals reported gaining a greater understanding and appreciation of patients’ medical condition through doctors explaining procedures and terminology; elaborating on rationales and evidence base for their decisions; and providing a medical overview on unusual cases. This in turn was thought to positively influence patient care. When the staff specialist attended the meeting, others gained valuable insight into his/her thinking and decision-making. One nurse explained this gave ‘‘a better understanding sometimes of why we’re doing certain things for patients’’ (Nurse, Team A). However, some participants felt learning was inhibited by the ‘‘medical model’’ of care adopted, defined by one nurse as

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‘‘where you’ve got dominance of medical staff who work towards wellness and healing and clinical intervention is the focus of that care’’ (Nurse, Team B). As one physiotherapist explained, the meeting ‘‘clearly defines what’s happening from a medical point of view, but doesn’t branch outside of that clinical viewpoint’’ (Physiotherapist, Team B). This limited participants’ learning about the patient and hence their provision of care, particularly around discharge planning. The ‘‘medical model’’ also appeared to influence participants’ confidence in raising and challenging controversial issues within the meeting. Some participants suggested that this was due to the power dynamics and medical hierarchy influence. One nurse noted a sense of ‘‘I’m the consultant. I’m making decisions. Therefore I don’t really care what you’re saying’’ (Nurse, Team A). For another participant, there was a feeling of medical centricity, where its ‘‘. . . all about medical and we all just sort of run, sort of keep up sometimes’’ (Occupational therapist, Team A). Our findings indicate differences in perceptions of how medical staff viewed learning from others in the meeting. Participants, other than doctors, spoke about doctors’ lack of interest or willingness to learn from other health professionals. This was often linked to their perceptions of the openness or otherwise of communication within the meeting. These views were in contrast to those expressed by doctors. For junior medical staff, learning was often directed to understanding the scope of practice of the other health professionals in the team. Senior doctors learnt more about services and resources, and psychosocial and functional status of the patient through interactions with other health professions. This practical insight was particularly useful and often integrated into the patient consultation. So often in terms of a gut feeling of whether a patient is well or unwell or can get home or can’t get home, or if there is a psychological, uhm depressed, often the nurses will have an insight into that, that we don’t have. We don’t have that as close a relationship as they do. (Doctor, Team A) A number of doctors wanted more input from the other health professionals at the meetings, particularly in expanding on their assessments, interventions and academic knowledge: I do want to know more about why physiotherapists conclude definitively that this person will never get home. Whereas they look quite kind of quite good to me. Uhm, what makes them think that. Uhm, so it just kind of expands my knowledge. (Doctor, Team B)

Discussion Findings from this study suggest that the IPT meeting is a place for health professionals to learn from each other. Knowledge gained from the meeting was thought to benefit not only the individual practitioner but, for some teams, contributed to collective learning ultimately benefitting patients. The potential for IPL was strengthened by increased interaction and participation from team members during meetings. The range of conceptions of learning identified within the team meeting suggests varying awareness of the learning potential of the meeting. This supports previous views that informal learning opportunities are generally unrecognized and poorly utilized within the health workplace (Barr, 2009; Cole, 2004; Manley, Titchen, & Hardy, 2009). This is also consistent with the perception that team meetings are primarily for exchanging

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information directly related to patient care rather than learning (Bokhour, 2006). In contrast to Lloyd et al. (2014), we did not find a difference in conceptions of learning based on years of experience. Rather, differences were related to profession and explicitness of learning within the meeting. This study suggests that by making the learning process explicit, individual knowledge and collective knowledge within the team can be enhanced. One team in the study had begun this process by including a focus on learning in its meeting terms of reference. Furthermore, most participants from this team indicated the opportunity to learn as a motivator for attending the meeting. The domains of knowledge identified in this study are not new in the literature. However, their application to the IPT meeting highlights the complexity of IPL. Schwandt (2005) refers to practical knowledge: the intuitive practical wisdom, often gained through experience and context, often tacit or implicit in nature, embodied in action and engagement with others. He argues this type of knowledge is fundamental to the practice setting yet is often eclipsed by the focus on the traditional scientific evidencebased view of knowledge. While many of our participants described experiences related to practical knowledge, its devaluing by some non-medical participants is consistent with Schwandt’s (2005) summation. This warrants further investigation given its link with patient care. The findings suggested that doctors were the main source of academic knowledge, what others refer to as propositional knowledge (Biggs, 2003; Higgs & Titchen, 1995). Stephenson (2004) suggests that through sharing of interprofessional knowledge bases, we gain insight into how different professions incorporate evidence into practice. In turn, this might help team members challenge current thinking and lead to further learning. Participants in our study spoke of challenges to medical thinking (usually led by other medical staff) and its impact on subsequent patient care decision making. However, other professionals at the meeting rarely provided academic knowledge. We can only surmise why this might be the case. Non-medical staff may have less practice at presenting knowledge in this way; they might perceive this knowledge as not relevant to share or they may assume that others already know it. Again, this highlights the need for a team discussion on what type of knowledge is relevant to share within the meeting. Our findings suggest professions come with different domains of knowledge and that this knowledge adds to the collective knowledge of the team. Mylopoulos and Scardamalia (2008) refer to this as a collaborative knowledge process arguing that it is through this iterative process that improvement and innovation can occur. While their work was primarily with doctors, collective knowledge development is applicable across the health professions. An important component of IPL therefore, is recognizing how we can best pool in real time, the knowledge present to enhance the collective knowledge within the team meeting. A team discussion on what type of information is relevant to the team meeting might be a way of improving learning within the meeting. However, our findings also suggest insight into one’s own capability, what Smith (2006) terms self knowledge, compliments this collective knowledge process. These findings suggest a need for guidance on when and how to enhance participation. Establishing and regularly discussing ‘‘ground rules’’ or principles of attendance might be a useful approach to improve participation. Study findings also suggest that individuals must take some responsibility for developing skills to enable them to participate in team meetings. As Billett (2014) suggests, there needs to be a willingness by participants to engage with their interprofessional co-workers. Edwards et al. (2009) argue that unless health professionals can identify and articulate their own expertise, it becomes difficult for others to

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recognize and utilize it. These findings support this and have important implications for education of health professionals. Most surprising was the finding of a mismatch between perceptions about who learns from whom within the IPT meeting. Similar to our findings, Baker, Egan-Lee, Martimianakis, and Reeves (2011, p. 101) found ‘‘frequent references to physicians’’ lack of interprofessional awareness by nurses and therapists. This was perceived as a possible disregard by doctors of other professions. However, recent studies with junior doctors (Burford et al., 2013; Weller, Barrow, & Gasquoine, 2011) support our findings that doctors valued informal learning from others. It might be that past experiences and engrained stereotypical views override actual experiences. In other words, the new generation of doctors do not fit the stereotypical view, yet non-medical participants might still hold onto this. Barr (2005) argues that a key focus of IPL is to appreciate the underlying similarities and differences in values, perceptions and cultures between health professionals. Study findings imply that values around learning across the health professions are poorly understood and clarification of these would be a wise starting point to enhance workplace IPL. This study highlights the underlying tensions between medical and other health professionals, an ‘‘us and them’’ attitude. This is reflected in participant comments on the ‘‘medical model’’ and suggests some participants felt under-valued by their medical colleagues. Medical dominance over other professions has a long history but arguably is declining with health system reform (Coburn, 2006; Willis, 2006) and models of care which address the complexity of interprofessional care (Brownie, Thomas, McAllister, & Groves, 2014; Kuipers, Ehrlich, & Brownie, 2013). An explicit focus on learning within the team meeting might be one way of reducing this divide between medical and non-medical professions. Most participants were critical of some aspect of the meeting process. However, only a few participants indicated a team approach to rectifying problems. Specific team learning in the sense of changing interprofessional practice was therefore limited. This is consistent with findings by Sutton and Dalley (2008) exploring reflection in intermediate care teams. They found limited evidence of team reflection and suggested that without this, teams are unlikely to gain new insights into their actions. Review of team meeting processes, including participation levels, is an important IPL process in itself and should be incorporated as part of the meeting process. Findings from this study have implications for patient safety. A learning culture needs to be created whereby team members feel safe to openly discuss theirs and others’ errors, (Carroll & Edmondson, 2002; Eisenberg, 2000). Familiarity with fellow team members and the ability, willingness and opportunity to share one’s knowledge all impact on patient safety. However, perhaps the most important link with patient safety is the opportunity to question and challenge the status quo, whether in relation to a patient’s current management, work processes or evidence base. Establishing team meeting expectations and creating an environment where all participants, regardless of profession, feel safe to contribute, are necessary steps to promote IPL and potentially improve patient safety. Study findings also support the need for interprofessional meeting facilitation and leadership training. This study has a number of limitations. First, it focused on one aspect of health professional practice: the IPT meeting. This context was chosen because it is an integral component of the interprofessional model of care delivery. It is recognized that other aspects of work practice also lend themselves to informal workplace IPL. For example, individual conversations between health professionals or daily ward rounds (Gregory, Hopwood, & Boud, 2014). Some teams in this research might have had other

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formal meetings, apart from the IPT meeting, that provided opportunities for IPL. Relationships between these meetings were not investigated. To contain study variables and set boundaries, the current research only included hospital-based teams. Transferability of findings to other contexts such as community based and primary care requires further exploration.

Declaration of interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

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Interprofessional team meetings: Opportunities for informal interprofessional learning.

This study explores the potential for workplace interprofessional learning, specifically the learning that occurs between health professionals as part...
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