1. Learning to be a Professional Enabling students to learn and work together in an interprofessional clinical placement Stefanie Bucher Clinical lead Speech and Language Therapist- Central North West London Foundation Trust Teaching fellow- Psychology and Language Sciences- UNIVERSITY COLLEGE LONDON

2. MSc Speech and Language Sciences 2 year clinical training programme as well as a challenging academic degree The core subject is speech and language pathology and working with clients and others professionals in health care and education Registration to Royal College of Speech and Language Therapists (RCSLT) and Health and Care Professions Council (HCPC)

3. Interprofessional learning “Interprofessional teamwork is described as team work whereby interactive effort, mutual planning, collective responsibilities and shared decision making is required. This is contrasted to multiprofessional working whereby the process is more linear and contributions are made in parallel or sequentially ” (Nancarrow etal, 2012)

4. The evidence that the NHS already know… In policy: NHS workforce strategy (Department of Health, 2000) which calls for education and training which is genuinely inter-professional In frameworks: “Co­ordinated person ­centred care and integrated service provision is critical” (NSF LT conditions, 2005) and..”clients should be treated by a specialist team and be involved in setting clear multidisciplinary goals” (Stroke Quality Standard, 2005) In SLT practice : “Integrated and coordinated working across community and acute settings is the most effective approach to supporting individuals with health needs” (RCSLT CQ3, 2006) and “SLTs should develop professional relationships as a member of a team” (HCPC SOPs, 2014)

5. The evidence in clinical education: Committed to supporting individual disciplines and promoting interdisciplinarity (Higher Education Academy, 2012) The UK Centre for the Advancement of Interprofessional Education (CAIPE) support a “new joint training across professions in communication skills and in NHS principles and organisation” (Barr, 2002, Barr and Low and Gray 2013) World Health Organisation (2010) a necessary step in preparing a “collaborative practice-ready” health workforce that is better prepared to respond to local health needs. Interprofessional Education Collaborative (IPEC, 2011) developed competencies for interprofessional collaborative practice in clinical education

6. The evidence in SLT clinical education: SLT students felt better prepared to work with a client who had had a stroke whilst within a multidisciplinary team and students felt that patients would ultimately benefit if healthcare students worked together to solve problems (Baxter, 2004) Cochrane and systematic reviews showed: -positive learning outcomes for learner’s attitudes, knowledge and skills of collaboration (Reeves etal, 2013) -that knowledge of each other’s professional role is a key characteristic of effective teamwork (Reeves etal, 2013) -‘shared patient care’ is a facilitator to collaborative learning (Mickan and Roger, 2005)

7. The placement 7 days out of 10 day placement allocated to interprofessional placement (IPP) Direct interdisciplinary working through: -focus groups/discussion groups -table top activities -allocated ‘IPP client’- mixed supervision across disciplines (eg team goal setting, joint assessment and therapy sessions) -peer professional self reflection and feedback sessions

8. The placement and learning outcomes (LOs with * from IEC 2011) TaskLearning outcome Day oneGeneral placement day Day two-Pre placement focus group session -Pre placement knowledge/skills and feedback form -Allocate ‘shared’ client (IPP client) for the placement -To explore the purpose and benefits of the interdisciplinary team -To explore perceptions knowledge of positive interdisciplinary teams and the skills and attributes of a person who works well within this team. -To explore professional boundaries and roles and how these can overlap in true interprofessional working. -To gather a baseline for knowledge, skill and confidence in working within an interdisciplinary team. -To explore how professional roles complement each other to enhance patient centred care* -To set group and individual objectives for the IPP that will contribute to the student’s own PDP.

9. Day three -IPP ward round -interview with IPP client- all three student carry out structured interview with client gather information and ascertain client’s perception of the roles of each professional. - Maintain competence in one’s own profession appropriate to scope of practice* -Respect the unique cultures, values, roles/responsibilities, and expertise of other health professions* -Develop a trusting relationship with patients, families, and other team members (CIHC, 2010). -Communicate one’s roles and responsibilities clearly to patients, families, and other professionals* Engage other health professionals—appropriate to the specific care situation—in shared patient-centered problem-solving* Day four -‘Classroom’ activity Students develop a Venn diagram following a discussion around their developing knowledge around:  How the roles overlap  What are the similarities/differences between roles  Advantages and disadvantages of MDT working  Define each other’s roles -SLT1, OT2 and PT3 plan their sessions with IPP client supported by their discipline specific practice educators (PE). These sessions will be attended by all 3 students. Eg SSLT/SLT PE+OT+PT Explain the roles and responsibilities of other care providers and how the team works together to provide care*

10. Day five -Team goal setting meeting for IPP client. SLT1, OT2 and PT3 present their interdisciplinary goals for the client to all PEs Joint sessions as mentioned in Day four -Communicate with team members to clarify each member’s responsibility in executing components of a treatment plan* -Forge interdependent relationships with other professions to improve care and advance learning* -Use unique and complementary abilities of all members of the team to optimize patient care. -Organize and communicate information with patients, families, and healthcare team members in a form that is understandable, avoiding discipline-specific terminology when possible* Day six Joint sessions as mentioned in Day four Day seven Joint sessions as mentioned in Day four Day eight -Pre placement focus group session -Pre placement knowledge/skills and feedback form -To explore the outcomes of each student’s objectives, the group objectives -To re examine knowledge and skills of working in a IDT. -To debrief and reflect on participating within the IDT clinical placement -To gather student feedback of the process and experience of the placement and to give sensitive, instructive feedback to others about their performance on the team, responding respectfully as a team member to feedback from others* -To reflect and give feedback upon the quality of care provided for the shared IPP client and how this may be advantageous to a unidisciplinary approach* -Express one’s knowledge and opinions to team members involved in patient care with confidence, clarity, and respect, working to ensure common understanding of information and treatment and care decisions* Day nineGeneral placement day Day tenGeneral placement day

11. How does IDT placement support students to learn to be a professional? Knowledge and skills link directly to NHS and SLT professional body regulations and practice guidelines Assist in making explicit often difficult to define ‘professional skills’ because many of the skills required to function well in the IDT are core professional skills eg- leadership, negotiation, collaboration and feedback to colleagues Allows ‘active testing’ of professional skills is in a supported, peer learning environment Facilitates deep learning regarding professional roles and self reflection by students Helps to foster development of professional community

12. Student comments I was participating in a physio session, I was looking at something that was slightly different and when we sat down and discussed it, we fed back on what we had focused on. SLT student In the joint sessions with SLT I learnt a lot about SLT techniques and about terms SLT use… One of the benefits of working in an IDT, and that’s something I didn’t think of before, was the support that the AHPs receive from each other. Physio student We delegated roles in a case history to avoid duplication and to structure it for the patient. [It was helpful] to explore the links between OT and other disciplines in an applied approach and to analyse the benefits and limitations of interprofessional working. OT student I think because they are peers, I feel more willing to ask questions that maybe I wouldn’t feel as comfortable approaching my PE about…You feel more like you can ask a question. Like I know this might be silly but can I ask you a question?

13. Further reading/information Nancarrow, S.A, Enderby, P.M., Ariss, S.M., Smith, S.A. Booth, A.Campbell, M.J. et al. (2012). Enhancing the effectiveness of interprofessional working: cost and outcomes. Final report, NIHR Service Delivery and Organisation Programme. Baxter, S.(2004) Perspectives and practice: speech and language therapy student views of an interprofessional learning experience Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M (2013) Interprofessional education: effects on professional practice and healthcare outcomes (update) (Review) The Cochrane Library, Issue 3 Mickan, S. M., & Rodger, S. A. (2005). Effective Health Care Teams: A model of six characteristics developed from shared perceptions. Journal of Interprofessional Care, 19, 358 – 370. Core competencies for interprofessional collaborative practice: Report of an expert panel. (2011) Washington, D.C.: Interprofessional Education Collaborative. Framework for Action on Interprofessional Education & Collaborative Practice (2010). World Health Organisation Barr H. (2002) Interprofessional Education Today, Yesterday and Tomorrow. Centre for Health Sciences and Practice and CAIPE UK Centre for the Advancement of Interprofessional Education, London. Barr, H, Low, H and Gary, R (2013) Introducing Interprofessional Education. CAIPE