How do interprofessional student teams interact in a primary care clinic? A qualitative analysis using activity theory

Abstract

Practice based interprofessional education opportunities are proposed as a mechanism for health professionals to learn teamwork skills and gain an understanding of the roles of others. Primary care is an area of practice that offers a promising option for interprofessional student learning. In this study, we investigated what and how students from differing professions learn together. Our findings inform the design of future interprofessional education initiatives. Using activity theory, we conducted an ethnographic investigation of interprofessional education in primary care. During a 5 months period, we observed 14 clinic sessions involving mixed discipline student teams who interviewed people with chronic disease. Teams were comprised of senior medicine, nursing, occupational therapy, pharmacy and physiotherapy entry level students. Semi-structured interviews were also conducted with seven clinical educators. Data were analysed to ascertain the objectives, tools, rules and division of labour. Two integrated activity systems were identified: (1) student teams gathering information to determine patients' health care needs and (2) patients either as health consumers or student educators. Unwritten rules regarding 'shared contribution', 'patient as key information source' and 'time constraints' were identified. Both the significance of software literacy on team leadership, and a pre-determined structure of enquiry, highlighted the importance of careful consideration of the tools used in interprofessional education, and the way they can influence practice. The systems of practice identified provide evidence of differing priorities and values, and multiple perspectives of how to manage health. The work reinforced the value of the patients' voice in clinical and education processes.

Implementing interprofessional learning curriculum: how problems might also be answers

“…While activity theory has been used in considerations of team work in clinical settings [ 32 , 33 , 38 – 41 ] its use in IPL is relatively novel. Activity theory has been applied to communication [ 42 ], student clinical placements [ 43 ], and team debriefings [ 44 ], but not specifically to curriculum development and implementation. Our study has used activity theory to reveal contradictions and tensions in IPL curriculum development and delivery.…”

Contradictions in clinical teachers’ engagement in educational development: an activity theory analysis

“…One theory that pays attention to interactions between the individual and the system is activity theory (Engeström et al 1999 ; Engeström 1987 ; Virkkunen and Newnham 2013 ). It has been proposed as a tool for studying complex issues in HPE (Varpio et al 2017 ) and has previously been applied to address different aspects of workplace learning (Reid et al 2015 ; de Feijter et al 2011 ; Larsen et al 2017 ) and group interactions (Kent et al 2016 ).…”

Weight Loss and Improvement of Metabolic Alterations in Overweight and Obese Children Through the I2AO2 Family Program: A Randomized Controlled Clinical Trial

“…As stressed by Wan (2018), programs such as these must be developed at primary care centers because of the unique combination of resources available and good management achievable in such settings. Furthermore, programs managed at primary care centers usually achieve better continuity of obesity prevention activities, thereby favoring long term follow-up (Kent et al, 2016). Reinforcing this hypothesis, Grant et al (2017) reported that interventions led by primary care nursing professionals both at the individual and community level, provided greater access to care resulting in cost savings and helping to empower social change.…”