Learning collaboration between primary and secondary care trainees: how to benefit optimally from primary care trainee hospital placements? A design based research project.

Background

The growing number of patients with multimorbidity and chronic illness has a direct impact on the growing number of health professionals involved with a single patient. The tendency is to provide care in a primary care setting as much as possible. This involves many transitions of both patients and knowledge between hospital and primary care. These transitions bring an increased risk of mistakes. Collaboration between doctors at the primary-secondary interface is essential to guarantee continuity of care. Therefore, to collaborate well, General Practitioners(GPs), Elderly care Physicians(EPs) and medical specialists should not only be proficient in their own professional work but also have knowledge of each other's expertise and roles. There is growing evidence that interprofessional education(IPE) between different professionals improves interprofessional collaboration and patient care. The commonly held opinion is, that the same applies to intraprofessional education(intraPE) between doctors from various disciplines. There are many calls to pay attention to primary-secondary care collaborative competencies during medical specialty training. However, it is difficult to organize intraPE between primary and secondary trainees who have divergent training schemes. It is known that the co-location of trainees contributes positively to learning outcomes with respect to collaborative competencies. GP and EP trainees have a six month hospital placement(HP) in their second year(GP/EP-HP). This forms a natural workplace setting where trainees from different specialties are working at the same department and have the opportunity to collaborate. However, learning intraprofessional collaboration(intraPC) is not yet formalized during HPs. It is therefore unknown whether and how learning of intraPC takes place in an informal way during these placements. When primary care trainees work in a secondary care setting, they engage in a form of ‘boundary crossing’. In educational science ‘boundary crossing’ is used to describe the situation where a trainee works in a setting that is outside of the boundary of his own work setting and culture. Boundary crossing brings with it a host of learning opportunities and activities. These learning activities can hinge on the use of boundary objects: tools used by two social communities in different ways. For example a discharge letter which has a different function for primary care specialists than it has in secondary care. Educational activities around boundary objects can stimulate intraPC.

Aim

The aim of this research project was: (1)to study how learning of intraPC takes place during GP/EP-HPs (2)to develop a toolbox and (3)an educational intervention for learning intraPC by both primary and secondary care trainees during these placements (4)to develop design principles to assist in organizing GP/EP-HPs with a focus on learning intraPC, in addition to the acquisition of medical competencies.  

Method

This research is a design based research(DBR) project. Characteristic for DBR is the systematic study of designing, developing and evaluating educational interventions as solutions for complex problems in educational practice, which also advances knowledge about the characteristics of these interventions and the processes of developing them. Trainees, supervisors, teachers and educationalists have an active role in the design, implementation and redesign, in order to formulate robust design principles that can be applied in other environments. A. Preliminary phase leading to ingredients for a blueprint for the intervention: A1. Scoping review of the literature on learning outcomes of GP/EP-HPs. A2. An ethnographic non-participatory observational study in the hospital during GP/EP-HPs to study whether and how intraprofessional learning takes place. A3. In depth interviews with supervisors and trainees focusing on what primary and secondary care trainees learn during their placements, and on what and how they would like to learn. B. Prototyping stage B1. Expert groups will develop a toolbox of interventions for the learning of intraPC based on A, and will discuss which intervention seems most promising and why B2. Based on B1 the research group chooses one promising intervention and redesigns it. B3. This intervention will be implemented and qualitatively and quantitatively evaluated with all relevant stakeholders. B4. Based on B3 the intervention will be redesigned, implemented and again qualitatively and quantitatively evaluated in a new group of stakeholders C. Assessment phase C1. Relating the results of B (including process and effect evaluations) with educational theory- in particular boundary crossing. Determining design principles of the intervention. C2. Describing final deliverables: (I)toolbox of interventions for learning intraPC (II)qualitatively and quantitatively evaluated intervention (III)theory driven and practice based design principles for the learning of intraPC.