전문직간학습의 공통역량 정의(Med Teach, 2017)

전문직간학습의 공통역량 정의(Med Teach, 2017)

Defining a set of common interprofessional learning competencies for health profession students

Maree O’Keefea, Amanda Hendersonb and Rebecca Chicka

aFaculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia; bGriffith University, School of Nursing and Midwifery, Brisbane, Australia

배경

Background

교수학습법에 대한 학제 간 및 / 또는 전문직 간interprofessional 접근에 대한 장벽으로는 다음이 있다.

• 여러 과목별 교육과정의 시간표를 조정하는 로지스틱한 과제

• 자원 제약, 

• 학제 간 평가 및 전문 인정위원회의 기대치 차이

• 학생 다양성, 

• 변화에 대한 전반적인 저항(Pecukonis 외 2008, Forte & Fowler 2009, Hoffman & Redman-Bentley 2012, Kezar & Elrod 2012). 

Frequently cited barriers to a more interdisciplinary and/or interprofessional approach to learning and teaching include 

• the significant logistic task of timetabling activities across different discipline curricula, 

• resource constraints, 

• disciplinary differences in assessment and professional accreditation council expectations, 

• student diversity, and 

• more general resistance to change (Pecukonis et al. 2008; Forte & Fowler 2009; Hoffman & Redman-Bentley 2012; Kezar & Elrod 2012). 

또한 한 대학의 다양한 보건 전문가의 대표성과 유용성으로 인해 복잡성이 있습니다. 이미 붐비는 커리큘럼에서 공간을 찾는 것 역시 큰 문제이다.

There are also complexities arising from the representation and availability of different health professions in any one university. Finding space in the already crowded curriculum adds further challenge.

학생들의 직업적 정체성의 발달과 사회화 과정은 미래의 interprofessional work을 위한 중요한 준비로 제안된다 (Arndt et al., 2009).

The development of students’ professional identity and socialization is proposed as an important preparation for future interprofessional work (Arndt et al. 2009).

학생에게 interprofessional context에서 [core disciplinary skills과 professional identity의 발달]과 [구체적인 interprofessional 지식과 기술의 발달]은 서로 구별 할 필요가 있다 (Nisbet et al. 2011). 많은 IPL 활동이 특정 Interprofessional 학습 역량 그 자체를 다루기보다는, interprofessional한 맥락에서 개별 분야의 core competency를 가르치는 방식으로 구성된다고 주장된 바 있다.

there is a need to distinguish between the intent to support development of core disciplinary skills and professional identity in an interprofessional context for students, and the development of specific interprofessional knowledge and skills (Nisbet et al. 2011). It can be argued that many interprofessional learning activities comprise core disciplinary competencies that are being taught in an than interprofessional context rather addressing specific interprofessional learning competencies per se.

Interprofessional practice와 환자 중심의 치료는 많은 요소와 의도를 공유합니다 (MacDonald 외 2010, Englander 외 2013, Fox & Reeves 2015).

Interprofessional practice and patient-centered care share many elements and intent (MacDonald et al. 2010;Englander et al. 2013; Fox & Reeves 2015). 

이러한 의료 발전과 함께, 대학들은 졸업생들에게 점점 더 명시적으로 협력과 팀워크 스킬을 강조하고 있습니다. 학습 성과와 "graduate attributes"에 대한 강조는, [고용에 필요한 능력에 대한 인식]을 높이고 [고용주와 지역 사회의 니즈와 기대에 대한 반응]을 반영한다 (Nisbet et al. 2011; Oliver 2013).

In parallel to these developments in health care, universities are more overtly committing to graduating students with skills in collaboration and teamwork. This emphasis on learning outcomes and “graduate attributes”  reflects a greater awareness of the abilities needed for employment and a responsiveness to employer and community needs and expectations (Nisbet et al. 2011; Oliver 2013). 

호주 내에서는 다른 많은 국가들과 마찬가지로 interprofessional 교육 및 실무 측면이 보건 전문가 교육 인증 표준에 나타나고 있습니다. 그러나 이러한 표준은 IPL 역량에 대한 구체적인 설명보다는 일반적인 원칙을 진술하는 방식으로 나타난다. 예를 들면 다음과 같습니다 : 

• "전문 간 연수의 원칙과 실습이 커리큘럼에 포함되어 있습니다"(Australian Dental Council 2014, 3 페이지); 

• "의료 프로그램은 학생들이 상호 전문 팀에서 일하고 학습하는 경험을 포함하여 다른 보건 전문가들과 함께 일하고 다른 의료 전문가들과 함께 학습 할 수 있도록 보장합니다."(Medical School Accreditation Committee 2012, 9 페이지);

Within Australia, as in many other countries, aspects of interprofessional learning and practice are appearing in health profession education accreditation standards. However, these standards tend to more general statements of principles than specific descriptions of interprofessional learning competencies. Examples include: 

• “principles of inter-professional learning and practice are embedded in the curriculum” (Australian Dental Council 2014, p. 3); 

• “the medical program ensures students work with, and learn from and about other health professionals, including experience working and learning in interprofessional teams” (Medical School Accreditation Committee 2012, p. 9);

이 연구의 목적은 모든 직업 군과 관련성이있는 IPL 역량 statement의 구체적 세트를 확인하는 것이 었습니다.

The aim of this study was to identify a specific set of interprofessional learning competency statements that have relevance for all health professions. 

방법

Methods

The authors reviewed six national and international interprofessional competency frameworks previously identified in a comprehensive report as “important and influential” (Interprofessional Curriculum Renewal Consortium 2013, p. 32). Together these frameworks provided a total of 165 competency statements (Table 1).

each framework was mapped to the Australian outcome Learning and Teaching Council (ALTC)learning statements for Health, Medicine and Veterinary Science (Table 2)(O’Keefe et al. 2011). 

• professionalism, 

• clinical practice, 

• health promotion, 

• evidence based practice, 

• collaboration and 

• life-long learning

A thematic analysis was conducted whereby the three authors 165 independently allocated each of the interprofessional statements to one of the six ALTC learning outcome categories (Braun & Clarke 2006).

Following this initial allocation, a word cloud analysis was undertaken for each ALTC learning outcome category (Worditout). All the statements allocated to a particular category were loaded into the online tool and a word cloud was generated.

Based on the relative font size used for each word in the word cloud, the 10 most frequently appearing words in each learning outcome category were identified and ranked in order of frequency. Where various forms of a word were included these were aggregated and the ranking order adjusted accordingly.

As a result of the activity described above, the 165 interprofessional learning statements were clustered into groups within each of the six ALTC learning outcome categories according to their content. Duplicate statements were identified within each group and removed. Common content was combined into single statements. Competencies that were deemed as core for health professional practice irrespective of whether this was uniprofessional or multiprofessional were also set aside as not being specifically required for interprofessional learning. Examples of statements deemed to reflect a core professional competency as distinct from a specific interprofessional competency included: 

• Develop trusting relationships with patients/clients/families and other team members (Canadian Interprofessional Health Collaborative 2010, p. 16); 

• Apply leadership practices that support collaborative practice and team effectiveness (Interprofessional Education Collaborative Expert Panel 2011, p. 25); 

• Uses knowledge of non-judgmental and anti-discriminatory practice when contributing to decision making processes in the interprofessional team (Combined Universities Interprofessional Learning Unit 2004, p. 69).

결과

Results

The distribution of the 165 statements across the ALTC learning outcome categories is shown in Table 3 along with the most frequently appearing words within each category.

A set of 12 draft competency statements was presented to the roundtable participants for review.

Table 4. The Interprofessional learning competency statements.

IPL competency statements

IPL의 원칙은 건강 관리에서의 개별 훈련의 역할을 이해하고 가치를 인정하며 존중하는 것을 포함합니다. IPP는 환자 및 인구의 이익을 보건 의료 전달의 중심에 둔다. IPP(interprofessional practice)의 핵심 요소는 헬스케어 전달에서 다른 보건 전문가의 기술을 인정하고 사용하는 것입니다. 그것은 관점을 명확히하고, 다른 보건 전문가로부터 통찰력과 학습을 가능하게하는 상호 작용에 의해 뒷받침됩니다.

The principles of interprofessional learning encompass understanding, valuing and respecting individual discipline roles in health care. Interprofessional practice places the interests of patients and populations at the center of health care delivery. A key element of interprofessional practice is the recognition and use of the skills of other health professionals in health care delivery. It is supported by interactions that clarify perspectives, and enable insights and learning from other health professions.

연구 프로그램이 끝나면 healthcare degree의 entry-level 졸업생은 다음을 수행 할 수 있습니다.

On completion of their program of study, graduates of any professional entry-level healthcare degree will be able to:

? 환자, 고객, 가족 및 기타 전문가들에게 전문 직업인으로서의 경험을 설명하십시오.

? 다른 보건 전문가의 업무 분야를 설명하십시오.

? 전문가의 의견을 유능하고 자신감있게 표현하고 discipline specific한 언어를 정중하게 피하십시오.

? 다른 건강 전문가와 함께 환자 / 고객 관리care 목표 및 우선 순위 계획

? 다른 건강 전문가와 함께 환자 / 고객의 보살핌care을 강화할 수있는 기회를 확인하십시오.

? 서로 다른 discipline의 관점에서 발생하는 환자 치료와 관련하여 불일치를 인식하고 해결합니다.

? 전문가 수준의 실무와 관련하여 프로토콜 및 관행을 비판적으로 평가합니다.

? 다른 직업의 동료에게시기 적절하고, 민감하며, 유익한 피드백을주고, 동료들로부터 피드백에 정중하게 응합니다.

Explain interprofessional practice to patients, clients, families and other professionals

Describe the areas of practice of other health professions

Express professional opinions competently, confidently, and respectfully avoiding discipline specific language

Plan patient/client care goals and priorities with involvement of other health professionals

Identify opportunities to enhance the care of patients/clients through the involvement of other health professionals

Recognise and resolve disagreements in relation to patient care that arise from different disciplinary perspectives

Critically evaluate protocols and practices in relation to interprofessional practice

Give timely, sensitive, instructive feedback to colleagues from other professions, and respond respectfully to feedback from these colleagues

이러한 심의의 결과는 원래의 12 개 역량 세트를 8 가지 IPL 역량의 집합으로 재구성하는 것이 었으며, 이를 통해 IPP에서 환자의 중심적인 위치를 분명히 하였다 (표 4) (건강직업 인증위원회 회의 2015).

the outcome of these deliberations was a redrafting of the original set of twelve competencies into a set of eight interprofessional learning competencies together with a new statement of principles that made clear the central place of the patient in relation to interprofessional practice (Table 4) (Health Professions Accreditation Councils' Forum 2015).

고찰

Discussion

앞에서 언급했듯이 여러 jurisdictions에서 개발 된 여러 프레임워크 및 IPL 역량 보고서가 존재하며, 종종 유사한 내용과 의도로 작성됩니다. 그러나 IPL 활동에 참여한 결과로 모든 학생이 획득 할 수있는 구체적이고 평가 가능한 역량은 분명하지 않습니다. 이러한 역량 집합은 각 개별 분야 내에서 기대되는 역량과 구별되어야 하며, 진정한 IPL 성과를 반영해야합니다.

As noted earlier, multiple frameworks and interprofessional learning competency statements exist that have been developed by different jurisdictions, often with very similar content and intent. However, the specific, assessable competencies to be acquired by all students as a result of participating in interprofessional learning activities have been unclear. Such a set of competencies should be distinct from competencies that are expected within each individual discipline and should reflect true interprofessional learning outcomes.

협력적 전문직 네트워크를 개발하기 위해서는 전문직 종사자들 사이에 IPL의 공통 모델이 수용되어야 한다(Bainbridge 2014). 과거의 분야별 학습 성과와는 달리 구체적이고 평가 가능한 IPL 성과에 대한 일반적인 합의가 이루어지지 않았기 때문에, 지금까지 각 대학은 학생들의 학습 활동 및 평가에서 촉진과 지원이 필요할 것으로 예상되는 것이 무엇인지에 대한 지침을 거의 제공하지 못했다. 또한 구체적 역량에서 파생된 구체적이고 평가 가능한 학습 성과가 없을 경우 IPL 평가는 성과보다는 프로세스에 초점을 맞출 위험이 있습니다.

The development of collaborative professional networks also requires the acceptance of common models of interprofessional learning across professions (Bainbridge 2014). A lack of general agreement on a set of specific and assessable interprofessional learning outcomes (as distinct from disciplinary learning outcomes) has in the past provided universities with very little guidance on what it is they were expected to be facilitating and supporting in learning activities and assessments with their students. It is also the case that in the absence of specific and assessable learning outcomes that are derived from specific competencies, there is a risk that the assessment of interprofessional learning will focus on process rather than outcome measures.

IPL 성과의 구체적이고 집중된 성격은 (건강 분야의 커리큘럼에 점차 효과적으로 적용되어온) 존경, 신뢰, 의사 소통 및 팀워크와 같은 분야별 핵심 스킬에 useful addition이 된다. 동시에 각 기관은 예상되는 IPL 성과 달성을 지원하기 위해 특정 학습 활동을 지속적으로 선택할 수 있습니다. 보건 전문 분야에 걸쳐 단일 역량 세트를 공유하는 것은 IPL 커리큘럼 개발을 촉진할 것이다.

The specific and focused nature of the interprofessional learning outcomes are a useful addition to core disciplinary skills such as respect, trust, communication and teamwork that are increasingly being effectively accommodated into the curricula of health disciplines. At the same time institutions can continue to exercise choice in selecting specific learning activities to support achievement of expected interprofessional learning outcomes. Sharing of a single set of competencies across health professions should also facilitate interprofessional learning curriculum development.

마지막으로, 이 연구는 기존의 statement들이 보건 전문가들 간의 상호 작용에만 중점을 두었으며, 환자 / 고객에 대한 언급은 놀랍게도 거의 없었음을 드러냈다. IPP의 기본 정신이 환자 중심의 진료를 촉진하고 환자의 건강 결과를 최적화하는 것이라면 환자에게 더 큰 초점을 맞출 필요가 있다. 이번 연구에서 도출한 역량 선언문statement에는 "IPP는 환자 및 인구의 이익을 의료 전달의 중심에 둔다"라는 초기 진술이 있습니다 (표 4).

As a final observation, undertaking this activity highlighted an emphasis on interactions between health professionals in existing statements. References to patients/client were surprisingly few. If the underlying ethos of interprofessional practice is to promote patient centered care and optimize patient health outcomes, there may still be a need for a greater focus on the patient. In the current set of competency statements, there is an initial statement of principle that “interprofessional practice places the interests of patients and populations at the center of healthcare delivery” (Table 4).

---

Med Teach. 2017 May;39(5):463-468. doi: 10.1080/0142159X.2017.1300246. Epub 2017 Mar 23.

Defining a set of common interprofessional learning competencies for health professionstudents.

O'Keefe M1, Henderson A2, Chick R1.

Author information

1

a Faculty of Health and Medical Sciences , The University of Adelaide , Adelaide , Australia.

2

b Griffith University, School of Nursing and Midwifery , Brisbane , Australia.

Abstract

INTRODUCTION:

Increasingly recognized as a core component of contemporary health profession education, interprofessional learningoutcomes remain difficult to define and assess across disciplines. The aim of this study was to identify a single set of interprofessionallearning competency statements with relevance to all health professions.

METHODS AND RESULTS:

Six national and international interprofessional competency frameworks were reviewed and combined to give a total of 165 competency statements. Following a process of mapping and grouping these statements into common content areas, duplicate content was removed. In addition, content deemed as a core competency for one or more individual health professions was removed. A round table of experts reviewed the remaining statements and agreed a final set of eight. Each statement was expressed as a specific learning outcome that could be assessed and which described behaviors and practices that students could routinely expect to engage with, and participate in, during the course of their study.

CONCLUSION:

Identifying specific interprofessional competencies that students of all health professions require will enable more effective implementation of interprofessional learning activities and assessment within the core curriculum.

PMID:

 

28332419

 

DOI:

 

10.1080/0142159X.2017.1300246