Interprofessional Training in a Psychiatric Study Unit

Research question and basic idea:

Interprofessional collaboration is a skill that many health professionals need to develop. Interprofessional training offers a way to improve collaboration and patient care. The increasing number of psychiatric patients with complex needs, requires mental healthcare providers to enhance their skills. It necessitates that healthcare professionals collaborate effectively; nevertheless, many have not been trained in an interprofessional environment. Health professionals lack sufficient knowledge of other professional roles and competences to engage in teamwork. Interprofessional study units have been designed to create an optimal learning environment for healthcare students. These study units provide a new environment for learning, where students can learn from each other and develop competence in interprofessional collaboration. This collaboration gives students from several health professions an opportunity to achieve a greater understanding of the overall picture of the patient´s life. The limited data available suggest interprofessional collaboration interventions can improve health-care processes and outcomes; however, better designed studies are needed.

Objective: Therefore, we will investigate whether placement at a psychiatric training unit compared with placement at a standard psychiatric ward improves students' interprofessional skills and patients' health status and satisfaction.

Methods Design We designed a non-randomized intervention study with an intervention group (interprofessional training unit) and a comparison group (conventional inpatient ward). Patients were included in the period October 2016 - March 2018. The two wards were comparable in terms patient categories (psychiatric diagnoses), and the size, staffing and design of wards (17 single-bed rooms in each ward). Students in the intervention group receive interprofessional training in the training unit in Slagelse (SL3), while students in the comparison group receive conventional training in a standard wards (SL2,SL4,SL5). The intervention is an interprofessional clinical training unit including students from nursing, medicine, psychology, social work and nursing assistants.

Questionnaires were administered to both groups at the beginning (T1) and end of hospitalization (T2).

Sample size and feasibility:

We powered the trial at 80% (α=0.05) to detect an effect size of 0.4, which we regarded as reasonable for determining clinically meaningful differences between interventions. Based on the power calculation we needed 120 patients per group Likewise, we conducted a power calculation regarding the students based on findings in a cross-sectional study. We used the students' interprofessional skills as the primary outcome. In the cross-sectional study the students had a mean score (RIPLS) of 69.98 (SD 25.5). When the sample size was calculated, 70 students were needed in both the intervention and the control group. 82 students have clinical placement in the psychiatric study unit in Slagelse annually (SL3) and 67 students have clinical placement in the standard psychiatric wards (SL2, SL4 and SL5). Therefore, it seems realistic to include 190 students within 18 months.

Participants:

Students taking part in their clinical placement in Psychiatry West in Slagelse. Primarily including students from Nursing, in their 3rd year clinical placement, graduate medical students 4th term, clinical placement in psychiatry and nursing assistants in their 2nd year clinical placement. Students from the intervention group are similar to the comparison group in terms of stage of education and duration of clinical training.

Inpatients aged 18-65 suffering from psychiatric disorders such as schizophrenia, psychosis, major depression, bipolar disorder, or severe personality disorder, and admitted October 2016 - March 2018, were included.

Allocation and recruitment:

After primary admission in the emergency ward, the patients were referred to inpatient wards based on their home address.

Students in both groups are allocated by program coordinators and supervisors from the involved university and colleges (University of Copenhagen, University College Zealand and Social and Healthcare College Zealand). The supervisors are responsible for the two groups of students and provided lists of names.

Data were entered into the EasyTrial © online Clinical Trial Management system. Data were labelled with unique identifiers, and all personal identifiers were removed or disguised during analysis to preclude personal identification.

Intervention:

In 2015, Psychiatry in Slagelse established an interprofessional clinical training unit. The aim was to create a new environment for learning, where students could learn from each other and develop competence in interprofessional collaboration. In the training unit there are more students than in the other standard psychiatric wards and several professions are included.

A facilitator team is responsible for the interprofessional training. In autumn 2016 seven professionals participate in course of facilitating interprofessional collaboration and training. The intervention involved the total staff participation in an initial eight-hour interactive workshop on the subject.

The training unit is based on two educational interventions: Student participation in clinical care teams and interprofessional group tuition sessions.

Clinical care team:

The interprofessional clinical care team ensures that the patient pathways are well-planned and well-coordinated. Professionals included in the patient's care are part of the team alongside with the patient and their relatives. In the training unit the students are also part of the team. The team meets weekly. The team conference is an important interdisciplinary element in support of patient care during hospitalization. This is very important as patients' needs are often complex.

Interprofessional group tuition:

Interprofessional group tuition is a method to improve professional reflection on clinical practice. Patients in the training unit and their treatment and care are in focus. The group tuition takes an entire day with a mixture of theory and patient cases, in which all professional groups of students participate. The supervisors are responsible for planning the sessions.

Ethical considerations:

The study is licensed by the Danish Data Protection Agency (2008-58-0020) and needed no further ethical approval according to Danish legislation (16-000014). Data is anonymized and stored in a secure server. Students and patients will be informed about the project and its purpose immediately before participation. The return of questionnaires will be considered consent to participation.

Time schedule:

Data collection is started October 2016 and will run for 18 months. Data analysis will start January 2018. Publications are planned for 2018. The PhD study is scheduled for 3 years and will end on 31 March 2019.