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Interprofessional education: effects on professional practice and healthcare outcomes (update)

  1. Scott Reeves1,*,
  2. Laure Perrier2,
  3. Joanne Goldman2,
  4. Della Freeth3,
  5. Merrick Zwarenstein4

Editorial Group: Cochrane Effective Practice and Organisation of Care Group

Published Online: 28 MAR 2013

Assessed as up-to-date: 3 AUG 2011

DOI: 10.1002/14651858.CD002213.pub3


How to Cite

Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD002213. DOI: 10.1002/14651858.CD002213.pub3.

Author Information

  1. 1

    University of California, San Francisco, Center of Innovation in Inteprofessional Education, San Francisco, California, USA

  2. 2

    Li Ka Shing Knowledge Institute of St. Michael's Hospital, Continuing Education and Professional Development, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

  3. 3

    Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Centre for Medical Education, Institute of Health Sciences Education, London, UK

  4. 4

    University of Western Ontario, Department of Family Medicine, London, ON, Canada

*Scott Reeves, Center of Innovation in Inteprofessional Education, University of California, San Francisco, 521 Parnassus Avenue, CL112, San Francisco, California, 94143, USA. scott.reeves@ucsf.edu.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 28 MAR 2013

SEARCH

 

Summary of findings    [Explanations]

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Index terms

 
Summary of findings for the main comparison.

Interprofessional education to improve professional practices

Patient or population: professionals or patients involved in interprofessional education intervention

Settings: primarily USA and the UK

Intervention: use of interprofessional education to improve collaboration and patient care

Comparison: separate, profession-specific education interventions; or no education intervention

OutcomesImpactsNo of studiesQuality of the evidence
(GRADE)*

Patient outcomesThe care provided by use of interprofessional education may lead to improved outcomes for patients6⊕⊕⊖⊖

Low

Adherence ratesThe use of interprofessional education may lead to changes in the use of guidelines or standards (e.g. adherence to clinical guidelines) among different professions3⊕⊕⊖⊖

Low

Patient satisfactionPatients may be more satisfied with care provided by professionals who have participated in an interprofessional education intervention2⊕⊕⊖⊖

Low

Clinical process outcomesChanges in clinical processes (e.g. shared decisions on surgical incisions) may be linked to the use of interprofessional education1⊕⊕⊖⊖

Low

Collaborative behaviourWe are unable to assess adequately the extent to which different professions behave collaboratively in the delivery of care to patients3⊕⊖⊖⊖

Very low

Error ratesWe are unable to assess adequately the reduction of error due to improved interprofessional education1⊕⊖⊖⊖

Very low

Practitioner competenciesWe are unable to assess adequately the competencies (e.g. skills, knowledge) of professionals to work together in the delivery of care1⊕⊖⊖⊖

Very low


*GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

 

Background

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Index terms

This review is an update to a previous Cochrane interprofessional education (IPE) review wherein four of the six included studies reported a range of positive outcomes (Reeves 2008). While that review was an improvement from the original Cochrane IPE review that identified no studies for inclusion (Zwarenstein 2000), it marked only a small step forward in establishing the evidence base for IPE due to the small number of studies, methodological limitations, and the heterogeneity of IPE interventions. This updated review is timely not only due to the passage of time but also given the continued interest and investment in IPE by policymakers, educators, healthcare professionals and researchers worldwide. 

IPE occurs when members of more than one health or social care profession (or both) learn interactively together, for the explicit purpose of improving interprofessional collaboration or the health/well being of patients/clients (or both). The widespread advocacy and implementation of IPE reflects the premise that IPE will contribute to developing healthcare providers with the skills and knowledge needed to work in a collaborative manner (CIHC 2010; Interprofessional Educ Collab Expert Panel 2011; WHO 2010). Interprofessional collaboration, in turn, is identified as critical to the provision of effective and efficient health care, given the complexity of patients' healthcare needs and the range of health-care providers and organisations. Interprofessional collaboration has been linked to a range of outcomes, including improvements in patient safety and case management, the optimal use of the skills of each healthcare team member and the provision of better health services (Berridge 2010; Reeves 2010; Suter 2012; Zwarenstein 2000).

Professional and academic leaders from diverse countries have developed a shared vision and strategy for postsecondary education in medicine, nursing and public health. This commission called for, among other recommendations, IPE that breaks down professional silos while promoting collaborative relationships (Frenk 2010). Similarly, the World Health Organization (WHO) published a report that outlined the role of IPE in preparing healthcare providers to enter the workplace as a member of the collaborative practice team (WHO 2010). National organisations have created core competencies for interprofessional collaborative practice, positioning IPE as fundamental to practice improvement (CIHC 2010; Interprofessional Educ Collab Expert Panel 2011).

Ideally, IPE should begin in the early training period and extend throughout a person's professional career (Barr 2005). Many examples of IPE at different stages of professional development continue to be published. From this work, it is possible to see that IPE can have an impact on learners' attitudes, knowledge and skills of collaboration (e.g. Charles Campion-Smith 2011; Makowsky 2009; Sargeant 2011). These are important educational outcomes, but not the focus of the current review.

Given the ongoing emphasis on the importance of IPE to collaborative practice and ultimately to healthcare processes and outcomes, ongoing attention is needed to advancing the research evidence related to IPE. It is timely to undertake this updating review to identify whether there are additional studies with research designs that meet the criteria of this Cochrane review, which can further inform the evidence of IPE.

 The definition of an IPE intervention used in this review is the following:

  • An IPE intervention occurs when members of more than one health or social care (or both) profession learn interactively together, for the explicit purpose of improving interprofessional collaboration or the health/well being (or both) of patients/clients. Interactive learning requires active learner participation, and active exchange between learners from different professions.

 

Objectives

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Index terms

The two objectives of this review are:

  1. to assess the effectiveness of IPE interventions compared to separate, profession-specific education interventions in which the same professions were learning separately from one another;
  2. to assess the effectiveness of IPE interventions compared with control groups which received no education intervention.

In the first objective we are seeking to understand the effects of IPE better in relation to the current dominant uniprofessional education model, where ideally the control group should receive the same education in a uniprofessional manner. We included the second objective as there was a lack of studies addressing the first objective. Our rationale for doing so was that while studies that do not meet the first objective are not as rigorous as those that do, such studies do nevertheless have value in providing some indication of the effects of IPE.

 

Methods

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Index terms
 

Criteria for considering studies for this review

 

Types of studies

Randomised controlled trials (RCTs), controlled before and after (CBA) studies and interrupted time series (ITS) studies.

 

Types of participants

Health and social care professionals (e.g. chiropodists/podiatrists, complementary therapists, dentists, dieticians, doctors/physicians, hygienists, psychologists, psychotherapists, midwives, nurses, pharmacists, physiotherapists, occupational therapists, radiographers, speech therapists and social workers).

 

Types of interventions

All types of educational, training, learning or teaching initiatives, involving more than one profession in joint, interactive learning, as described in the IPE definition above.

 

Types of outcome measures

1. Objectively measured or self reported (validated instrument) patient/client outcomes in the following areas: health status measures; disease incidence, duration or cure rates; mortality; complication rates; readmission rates; adherence rates; satisfaction; continuity of care; use of resources (e.g. cost-benefit analyses).

2. Objectively measured or self reported (validated instrument) healthcare process measures (e.g. skills development, changes in practice style, interprofessional collaboration, teamwork).

 

Search methods for identification of studies

See: Cochrane Effective Practice and Organisation of Care Group methods used in reviews.

Effective Practice and Organisation of Care Group (EPOC) specialized register (epoc.cochrane.org/epoc-register-studies), July 2006 to 2 August 2011.

The search strategy from the previous IPE Cochrane review was adapted for each of the following databases searched: 

  • MEDLINE August week 4 2006 to July week 3 2011;
  • CINAHL, July 2006 to 2 August 2011.

See Appendix 1 and Appendix 2 for the search strategies

No language restrictions were placed on the search strategy.

We also handsearched the Journal of Interprofessional Care (2006 to 2011), proceedings from key interprofessional conferences - 'All Together Better Health' (Sydney, April 2010) and 'Collaborating Across Borders' (Minneapolis, October 2007 and Halifax, May 2008) and the grey literature contained on the websites of the UK Centre for the Advancement of Interprofessional Education (date accessed: 15 September 2011) and the Canadian Interprofessional Health Collaborative (date accessed 16 September 2011). In addition, we drew on our international networks to ensure that all relevant published and unpublished work in the field would be identified. These searches generated 76 abstracts. See Figure 1.

 FigureFigure 1. Flow diagram.

(*Total refers to sum of 1999 review and updates in 2008 and 2012).

A total of 3069 abstracts were found: 1248 from CINAHL, 285 from EPOC, 1460 from MEDLINE, 76 from handsearching and conference abstracts. After duplicates were removed, 2733 abstracts remained. While the abstract search was sensitive to identifying a high proportion of relevant IPE intervention studies, it exhibited low specificity in relation to differentiating between IPE interventions and other interprofessional teamwork interventions without IPE components, such as continuous quality improvement and total quality improvement initiatives. See Figure 1 for further information.

 

Data collection and analysis

Three review authors (SR, LP and JG) independently reviewed the 2733 abstracts retrieved by the searches to identify all those that suggested that: 

  1. there was an intervention where interprofessional exchange occurred;
  2. education took place;
  3. professional practice, patient care processes or health or patient satisfaction outcomes were reported;
  4. the intervention was evaluated using an RCT, CBA or ITS design.

Twenty-eight studies were identified from this abstract search as potentially meeting these criteria. The full text of these articles was obtained. These three review authors independently assessed each full-text article to examine whether it met all of the criteria further. Any disagreements and uncertainties were resolved by discussion, and the input of a fourth review author (MZ), who reviewed all of the final papers as a further quality check for inclusion in the review. Nine studies met the outlined criteria; these nine studies were added to the six studies from the previous review for a total of 15 studies.

 

Assessment of the risk of bias in included studies

Two review authors (SR and LP) assessed the risk of bias for each study using a form with the standard criteria described in EPOC (2002). The 'Risk of bias' assessments are displayed in Figure 2 and Figure 3. The 'Risk of bias' summary is in Figure 4.

 FigureFigure 2.
 FigureFigure 3.
 FigureFigure 4. Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

We did not exclude studies on the grounds of risk of bias, but sources of bias are reported when presenting the results of studies.  

 

Data extraction

Three review authors (SR, LP and JG) extracted the following information from included studies:

  1. type of study (RCT, CBA, ITS);
  2. study setting (country, healthcare setting);
  3. types of study participants;
  4. description of education programme;
  5. description of any other interventions in addition to the education;
  6. main outcome measures;
  7. results for the main outcome measures;
  8. any additional information that potentially affected the results.

 

Analysis

Ideally, a meta-analysis of study outcomes would have been conducted for this review. However, this was not possible due to heterogeneity of study designs, interventions and outcome measures among the small number of included studies (n = 15). Consequently, the results are presented in a narrative format.

 

Results

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Index terms
 

Description of studies

See: Characteristics of included studies; Characteristics of excluded studies.

All 15 studies addressed objective number two – to assess the effectiveness of IPE interventions compared with control groups that received no education intervention. Given the major differences between the included studies, a description of each is provided below. A formal calculation of the evidence, including the creation of a 'Summary of findings' table, was not feasible given the lack of overlap among the outcomes reported. The included studies are presented in three sections according to the type of research design they employed.

 

Randomised controlled trials

Barcelo 2010 described an RCT that aimed to improve the quality of diabetes care in primary healthcare centres using the chronic care model. Forty-three primary care teams based in 10 public health centres participated in this study. Teams were made up mainly of physicians and nurses with other professionals, such as nutritionists and psychologists also participating in some teams. All 10 health centres implemented a clinical information system and provided the opportunity for patients to participate in peer support groups. Beyond this, five health centres were randomly assigned to receive the intervention, and five received no intervention. The intervention consisted of a multifaceted quality improvement initiative during which teams and patients participated in three interprofessional learning sessions within a period of 18 months. These included a structured patient diabetes education programme, training in foot care and in-service training. In each of the three learning sessions, the teams selected specific objectives for 'plan-do-study-act' (PDSA) improvement cycles. The objectives were based on problems identified in the practice of each health centre (e.g. organisation of care, decision support, information sharing). Other aspects of the multifaceted quality improvement programme included support from hospital specialists and a case management advisor. Reported outcome measures included clinical observations (e.g. metabolic control and cholesterol) and adherence to clinical protocols (e.g. conducting periodic foot and eye examinations). The authors reported that multilevel logistic regression models were adjusted for the clustering of participants within health centres.

Brown 1999 undertook an RCT that aimed to examine whether an interprofessional communication skills training programme for physicians, physician assistants, nurse practitioners and optometrists increased participants' ratings of clinicians' communication skills. The healthcare professionals worked for a 'not for profit' group-model health maintenance organisation (HMO) in the US. The IPE intervention, led by two physicians, consisted of two four-hour workshops delivered one month apart with two hours of homework and a telephone call from an instructor inbetween. The intervention involved didactic components, role playing and interactive dialogue. Of the 69 participants (75% of whom were physicians), 37 were randomly assigned to receive the intervention and 32 were assigned to the control group (which received the IPE intervention after the study). Pre- and post-intervention patient satisfaction scores were drawn from routine data collection, which yielded clinician-specific patient satisfaction ratings every six months. The HMO contracted out the routine data collection. The contractor randomly sampled clinical consultations and mailed a questionnaire to the relevant participants within 10 days of each consultation in the sample.

Campbell 2001 described an RCT that evaluated an interprofessional training programme for emergency department (ED) physicians, nurses, social workers, hospital administrators and representatives from local domestic violence service organisations. The intervention aimed to increase the identification of acutely abused women in EDs, and improve staff and institutional responses. The two-day programme, developed and implemented by violence prevention organisations, involved didactic instruction, role play, team planning and team work to develop a written action plan. Participants from each ED were asked to meet before and after the training. The programme addressed systems change and coalition building as well as provider attitudes and skill building. The attendees were expected to collaborate in order to implement system changes in their respective EDs, including implementing training for ED staff. The instructors were available for telephone assistance during the implementation phase. Six EDs were randomly assigned to receive either the IPE intervention (three hospitals) or to be in a control group that received no intervention (three hospitals). Follow-up data were collected at nine to 12 months and 18 to 24 months. 

Helitzer 2011 reported an RCT that evaluated the effects of an intervention aimed at improving patient-centred communication skills and proficiency in discussing patients' health risks. Twenty-six primary care professionals (physicians, physician assistants and nurse practitioners) based in a single academic setting participated in the intervention.  A total of 12 professionals were allocated to the intervention group and 14 to the control group. The intervention consisted of training focused on patient-centred communication about behavioural risk factors and included a full day of IPE, individualised feedback on video-taped interactions with simulated patients, and optional workshops to reinforce strategies for engaging the patient. Data were gathered from patients on professionals' patient-centred communication behaviour during two clinic visits that were held at six and 18 months following the intervention.

Nielsen 2007 described a cluster RCT study to evaluate the effectiveness of a teamwork training intervention in reducing adverse outcomes and improving the process of care in hospital labour and delivery units. Fifteen hospitals took part in this study, seven as intervention sites and eight as control sites. Participants included labour and delivery room personnel from obstetrics, anaesthesiology and nursing (n = 1307). The intervention consisted of a three-day instructor training session comprising four hours of didactic lessons, video scenarios and interactive training covering team structure and processes, planning and problem solving, communication, workload management and team skills. The intervention also included assistance with creation and structure of interprofessional teams at each intervention site, which entailed facilitators conducting onsite training sessions to structure each unit into core interprofessional teams. In addition, a contingency team, a group of physicians and nurses drawn from practitioners that were on call during a 24-hour period, were trained to respond in a co-ordinated way to obstetric emergencies. Data were gathered on adverse maternal or neonatal outcomes as well as clinical process data from 28,536 deliveries.

Strasser 2008 described a cluster RCT aimed at evaluating the effects of an IPE intervention on team functioning in stroke rehabilitation units. A total of 227 staff on 14 intervention teams and 237 clinical staff on 15 control teams participated in this study. All teams had representatives from medicine, nursing, occupational therapy, speech-language pathology, physiotherapy and social work. The team training intervention consisted of a multi-phase IPE programme delivered over six months, including: an interactive workshop emphasising team dynamics, problem solving, the use of performance feedback data and the creation of action plans for process improvement. The intervention also included follow-up telephone and video-conference consultations. Patient outcomes data (functional improvement, community discharge, length of stay) were gathered from 579 stroke patients treated by these teams before and after the intervention.

Thompson 2000a described a group RCT aimed at evaluating the effectiveness of IPE and a clinical practice guideline aimed at improving the recognition and improvement of depression in primary care practices. A primary care physician, practice nurse and community mental health nurse delivered the four-hour IPE seminars to general practitioners and practice nurses in groups of two or three practices when convenient. Teaching was supplemented by video-tape recordings, small-group discussion of cases and role play. The educators were available for nine months after the seminars to facilitate guideline implementation and promote use of teamwork. Fifty-nine primary care practices were assigned to the intervention group (29 practices) or control group (30 practices). Practices in the control group received the IPE intervention after the study had been completed. Data were collected six weeks and six months after patient visits.

Thompson 2000b undertook a cluster RCT to examine the effectiveness of a one-year intervention linked to improving identification of domestic violence and the collaborative management of primary care clinics. The intervention for teams of physicians, nurse practitioners, physician assistants, registered nurses, practical nurses and medical assistants, consisted of two half-day IPE sessions, a bimonthly newsletter, clinic educational rounds, system support (posters, cue cards, questionnaires) and feedback of results. Five primary care clinics were randomly assigned to receive the intervention (two clinics) or to the control group (three clinics). Data were collected at baseline, nine to 10 months, and 21 to 23 months.

 

Controlled before and after studies

Janson 2009 reported a CBA study aimed at improving the care and outcomes of people with type 2 diabetes by improving the care delivered by interprofessional teams. Participants consisted of interprofessional teams of 120 learners (56 second/third-year medicine residents, 29 second-year nurse practitioner students and 35 fourth-year pharmacy students) who delivered team-based diabetes care to 221 people. The control group consisted of 28 traditional-track internal medicine residents who provided usual care to 163 people. The study was undertaken in two general medicine clinics. The intervention involved weekly didactic presentations, clinical discussions and clinic visits with participants. A quality improvement approach was offered by planning and implementing projects using the plan-do-study-act model. The intervention group also received quarterly patient panel reports on process of care benchmarks and clinical status markers.

Morey 2002 presented a CBA study to evaluate the effectiveness of a programme aimed at improving collaborative behaviour of hospital ED staff (physicians, nurses, technicians and clerks). The intervention consisted of an emergency team co-ordination education course as well as implementation of formal teamwork structures and processes. A physician-nurse pair from each ED was involved in developing and implementing the curriculum. The course consisted of eight hours of instruction in one day. The format was lectures, discussion of behaviours, practical exercises and discussion of video-segments. Teamwork implementation involved forming teams by shift and delivering care in a team structure. Each staff member completed a four-hour practicum in which teamwork behaviours were practised and critiqued by an instructor. Staff supported the adoption of collaborative behaviour during normal shifts. This teamwork implementation phase lasted six months. Nine hospital EDs self selected to receive either the IPE intervention (six EDs, 684 clinicians) or act as a control (three EDs, 374 clinicians). Control group departments received the intervention at a later date. Data were collected at two four-month intervals following the training.

Rask 2007 presented a CBA study that aimed to evaluate an interprofessional fall management quality improvement project in nursing homes. Participants consisted of 19 interprofessional falls teams (made up of a nurse, physiotherapist or occupational therapist, certified nursing assistants, a member of maintenance staff). The control group comprised 23 falls teams. The intervention consisted of a full-day interprofessional workshop and a second workshop approximately one month later to address arising challenges. Organisational interventions were also provided in the form of seeking leadership buy-in and support, providing a designated facility-based falls co-ordinator, and ongoing consultation and oversight by advanced practice nurses with expertise in falls management. Data were gathered on process of care documentation, trends in fall rates and changes in physical restraint use.

Weaver 2010 described a CBA study that evaluated an intervention aimed at improving teamwork for operating room staff based at two community-based hospitals. In total, 55 professionals participated in the intervention: 29 in the intervention group (three surgeons, nine nurses, three surgical technicians, 12 anaesthesiologists, two physician assistants); and 26 in the control group (two surgeons, 18 nurses, three surgical technicians, three anaesthesiologists). The intervention consisted of one four-hour session that included didactic presentations and interactive role-playing activities between participants aimed at improving their knowledge and skills of teamwork and collaboration. Data were gathered by observed changes in collaborative behaviour (frequency of team briefings in which information was shared among team members and patient care was planned).

Young 2005 presented a CBA study that evaluated effects of a consumer-led innovation aimed at improving the competence of mental health practitioners working in community mental health provider organisations. The practitioner intervention for psychiatrists, nurses, therapists, case managers, residential staff, mental health workers, and administrative support involved six educational components held over a one-year period that included presentations, discussions, small groups and role-playing techniques, as well as three or four full-day follow-up visits to sites. An additional 16 hours was also spent with staff at the sites. The intervention was developed and delivered by two people who were consumers of mental health services. The innovation also involved a consumer-focused intervention. The study was conducted at five organisations in two states; one organisation in each state received the intervention (total of 269 mental health practitioners, 151 in intervention groups and 118 in control groups). Data were collected at baseline and one year.

 

Time interrupted series studies

Hanbury 2009 described an ITS study that aimed to test the effectiveness of a theory of planned behaviour intervention to increase community mental health professionals' adherence to a national suicide prevention guideline. The intervention was delivered to 49 participants. The intervention comprised three components designed to target normative beliefs. First, a presentation that contained factual statements, statistics and graphs taken from key government publications highlighting and supporting the guideline evidence base. Second, an interprofessional group discussion was facilitated to ensure that positive normative beliefs were emphasised and any negative normative beliefs challenged. Third, interprofessional group work based on two real life vignettes was undertaken by participants. Data in the form of aggregated, monthly audit adherence data were collected for nearly four years (28 months before the intervention and 18 months afterwards) to evaluate patterns of adherence to using the national suicide prevention guideline. Data from a control site was also included to evaluate the level of adherence.

Taylor 2007 presented an ITS study that assessed the effects an intervention designed to improve the delivery of standard diabetes services and patient care. Professionals based in a single primary care clinic participated in the study. An eight-hour intervention was delivered to participants. The intervention consisted of a range of interactive activities (task redistribution, standardised communication methods and decision-support tool development) that aimed to improve interprofessional communication, teamwork, workflow organisation and information exchange in order to enhance the care of 619 people with diabetes. Data were collected from medical records. Using 1805 clinic visits completed during the study period (160 pre-intervention clinic days and 122 post-intervention clinic days), diabetic services and associated patient outcomes were evaluated for adherence to the American Diabetes Association periodicity recommendations and treatment targets: quarterly blood sugar; quarterly blood pressure; annual low-density lipoprotein; annual urine microalbumin; and annual lower extremity amputation prevention check.

 

Risk of bias in included studies

The risk of bias in studies was variable. Data are presented for RCTs and CBA studies (Figure 2), and separately for ITS studies (Figure 3). 

 

All studies

For the eight studies that were RCTs, four met five of the nine EPOC 'Risk of bias' criteria (Brown 1999; Nielsen 2007; Thompson 2000a; Thompson 2000b). Three of the five CBA studies met five of the nine EPOC 'Risk of bias' criteria (Janson 2009; Morey 2002; Young 2005). The EPOC 'Risk of bias' criteria have seven elements for ITS studies and one of the two studies met four of the seven EPOC 'Risk of bias' criteria (Hanbury 2009).

 

Randomised controlled trials

Four of the eight RCTs reported adequately protecting against contamination (Campbell 2001; Strasser 2008; Thompson 2000a; Thompson 2000b). All of the RCTS demonstrated adequate similar baseline outcome measurements. Only one study was inadequate with regards to baseline characteristics being similar (Campbell 2001). Inadequate allocation concealment was an issue in four of the RCTs, with studies either failing to conceal allocation or not making this clear (Barcelo 2010; Campbell 2001; Helitzer 2011; Thompson 2000b). The same four RCTs were unclear or failed in their reporting of adequate sequence generation (Barcelo 2010; Campbell 2001; Helitzer 2011; Thompson 2000b). Four RCTs were unclear or inadequate with regards to the adequacy of blinding in the assessment of outcomes (Barcelo 2010; Helitzer 2011; Nielsen 2007; Strasser 2008). Three RCTs were unclear or had evidence of selective outcome reporting (Barcelo 2010; Brown 1999; Thompson 2000a). All RCTs had evidence of other bias.

 

Controlled before and after studies

Allocation concealment was an issue for all CBA studies. Four of the CBA studies did not address incomplete outcome data (Janson 2009; Rask 2007; Weaver 2010; Young 2005). Two of the studies did not demonstrate adequate sequence generation (Janson 2009; Weaver 2010); or selective outcome reporting and adequate blinding (Rask 2007; Weaver 2010). All CBA studies ensured baseline outcome measurements were similar with the exception of one (Weaver 2010). Two studies did not report similar baseline characteristics (Weaver 2010; Young 2005); or that the study was adequately protected against contamination (Rask 2007; Weaver 2010). Only two studies were free of other bias (Janson 2009; Morey 2002) (see Figure 2).

 

Interrupted time series studies

Both ITS studies were adequate for pre-specifying the shape of the intervention effect and for the intervention to be unlikely to affect data collection. Taylor 2007 was unclear in their reporting of whether the intervention was independent of other changes, and were inadequate with regards to selective outcome reporting. Hanbury 2009 did not address all incomplete outcome data. Both ITS studies were not free of other bias (see Figure 3).

 

Effects of interventions

See:  Summary of findings for the main comparison

Effects of IPE interventions reported in each of the studies are presented by the research design each employed.

 

Randomised controlled trials

The results of the study by Barcelo 2010 indicated that the proportion of people with good glycaemic control (glycosylated haemoglobin (HbA1c) < 7% (53 mmol/mol)) among those in the intervention group increased from 28% to 39% after the intervention (p value < 0.05). The proportion of people achieving three or more quality improvement goals increased from 16.6% to 69.7% (p value < 0.001) among the intervention group while the control group experienced a non-significant decrease from 12.4% to 5.9% (p value = 0.118).

In the study by Brown 1999, the communication skills training programme did not improve patient satisfaction scores. Based on an average of 81 responses for each of the 69 participating clinicians, there was no significant difference in the mean satisfaction scores for the intervention and control groups: each group showed a very small increase in mean scores on 9-point scales (intervention group 0.03 points and control group 0.05). 

The results in Campbell 2001 study indicated that the EDs that received the intervention to improve responses to acutely abused women recorded significantly higher levels on all components of the "culture of the emergency department" system-change indicator (e.g. appropriate protocols; materials such as posters, brochures, medical record intervention checklists and referral information available to staff; and staff training) (F = 5.72, p value = 0.04) and higher levels of patient satisfaction (F = 15.43, p value < 0.001) than the EDs in the control group. 

Helitzer 2011 reported that the intervention generated significant and persistent changes in patient-centred communication in the intervention group. After six months, a significant difference was found in scores for patient-centredness, which favoured the intervention group (F(1, 20.59) = 8.43, p value < 0.01). After 18 months, the intervention group's significantly higher patient-centredness scores were sustained (F(1, 17.16) = 5.48, p value = 0..032).

Nielsen 2007 found overall no statistically significant differences between the intervention and control groups. Data on adverse outcome prevalence were similar in the control and intervention groups, both at baseline and after implementation of teamwork training (9.4% versus 9.0% and 7.2% versus 8.3%, respectively). However, the time from the decision to the incision for an immediate caesarean delivery was significantly shorter in the intervention group (p value = 0.03). In addition, one process measure, the time from the decision to perform an immediate caesarean delivery to the incision, differed significantly after team training (33.3 minutes versus 21.2 minutes, p value = 0.03).

Strasser 2008 reported a significant difference in improvement in motor score between the intervention group and the control group (13.6% of people in the intervention gained more than 23 points, p value = 0.038). There was no significant difference for the other two outcome measures (p value = 0.1) for both. The proportion of people who had had a stroke making greater than the median functional gain increased by 4.4% in the intervention group, whereas it decreased by 9.2% in the control group, lending further support to the effect of the intervention. At the same time, the intervention had no measurable effect on participants' length of stay.

Thompson 2000a reported no differences between the intervention and control groups in relation to the recognition of depressive symptoms in their evaluation of the effectiveness of an IPE and clinical practice guideline intervention. The outcome for people diagnosed with depression did not significantly improve at six weeks or six months after the intervention. 

Thompson 2000b reported that following the intervention, documentation of domestic violence incidents increased by 14.3%. It is also stated that there was a 3.9-fold relative increase of documentation at nine months in intervention clinics compared to the control sites. Overall case finding increased by 30%, but this was not statistically significant. Recorded quality of domestic violence patient assistance did not change. 

 

Controlled before and after studies

Janson 2009 reported that, at study completion, intervention group participants more frequently received assessments of HbA1c (79% versus 67%; p value = 0.01), low-density-lipoprotein cholesterol (69% versus 55%; p value = 0..009), blood pressure (86% versus 79%; p value = 0.08), microalbuminuria (40% versus 30%; p value = 0.05), smoking status (43% versus 31%; p value = 0.02), and foot examinations (38% versus 20%; p value = 0.0005). It was also reported that intervention group participants had more planned general medicine visits (7.9 = 6.2 versus 6.2 = 5.7; p value = 0.006) than did control group participants.

The results of Morey 2002 evaluation of the effectiveness of an interprofessional teamwork training programme on collaborative behaviour in EDs, showed a statistically significant improvement in quality of observed team behaviours between the intervention and control groups following training (p value = 0.012). The clinical error rate significantly decreased from 30.9% to 4.4% in the intervention group (p value = 0.039). 

Rask 2007 reported that several key areas of documentation regarding assessment and management of fall risk factors improved. All except two were statistically significant for the intervention teams. Fall rates were not significantly different for the intervention nursing homes (p value = 0.92) and were significantly positive (p value = 0.008) for the control sites. Restraint use decreased substantially during the project period, from 7.9% to 4.4% in the intervention nursing homes (a relative reduction of 44%) and from 7.0% to 4.9% at the control sites (a relative reduction of 30%).

Weaver 2010 reported that intervention participants engaged in significantly more team pre-case briefings after attending training (F [1, 147] = 35.01, p value < 0.001). There was also a significant increase in the proportion of information sharing (e.g. intervention team members were more willing to speak up and participate during briefings) (F [1,128] = 11.47, p value < 0.001). This pattern was also present in the frequency of care plan discussions (F [1,145] = 5.00, p value < 0.05).

Young 2005 reported that in comparison to mental health practitioners in the control group, practitioners in the intervention group reported significantly higher scores in relation to the following competencies: teamwork (r = 0.28, p value = 0.003); holistic approaches (r = 0.17, p value = 0.06); education about care (r = 0.22, p value = 0.03); rehabilitation methods (r = 0.25, p value = 0.007) and overall competency (r = 0.21, p value = 0.02).

 

Time interrupted series studies

Hanbury 2009 reported that the intervention did not significantly increase adherence to the national guideline. Multiple regression was used to calculate the proportion of variance in intention accounted for by the predictors, and identify the most significant predictor. The intervention was found to account for 58% of the variance (adjusted R2 = 0.58) in intention to adhere to the guideline, a statistically significant finding (F = 23.586, 3 degrees of freedom (df), p value = 0.0001).  

Taylor 2007 found that the intervention achieved improvements in microalbumin testing (+7.40%, p value = 0.001) and HbA1c testing (+3.80%, p value = 0.029). A significant increase in microalbumin levels that were at target (+3.87%, p value = 0.018), and a significant decrease in HbA1c levels that were also at target (–3.81%, p value = 0.011). It is unclear in the reporting if the intervention is independent of other changes. In addition, outcomes were not assessed blindly.

 

Discussion

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Index terms

In total, this review included 15 studies, locating nine new studies, which were added to the six studies from the previous update (Reeves 2008). This small growth of eligible studies marks continued development of the IPE field, as the first IPE review found no eligible studies (Zwarenstein 2000).

Seven of the studies reported positive outcomes in the following areas: improvements in diabetes clinical outcomes and healthcare quality improvement goals (Barcelo 2010); improvements in patient-centred communication (Helitzer 2011); improved clinical outcomes for people with diabetes (Janson 2009); collaborative team behaviour and reduction of clinical error rates for ED teams (Morey 2002); increased rates of diabetes testing and improved patient outcomes (Taylor 2007); improved mental health practitioner competencies related to the delivery of patient care (Young 2005); and improved team behaviours and information sharing for operating room teams (Weaver 2010). Three of the studies also reported that the gains attributed to IPE were sustained over time: eight months (Morey 2002) and 18 months (Barcelo 2010; Helitzer 2011).

In addition, four studies (Campbell 2001; Rask 2007; Strasser 2008; Thompson 2000b) reported a mixed set of outcomes. As well as reporting positive outcomes in relation to changes in professional practice and patient satisfaction, Campbell 2001 found no differences in the identification rates of victims of domestic violence between their intervention and control groups. While Rask 2007 reported improvements in care documentation and decreases in the use of restraint for people in nursing homes, they found no change in fall rates. Despite reporting functional gains for patients, Strasser 2008 also reported no significant difference in length of stay or rates of community discharge for stroke rehabilitation patients. Thompson 2000b found that documented asking about domestic violence significantly increased, yet the increase in case finding was not significant.  

Four studies reported that the IPE interventions had no impact on either healthcare processes or patient health care or outcomes: Brown 1999 found no significant difference in the improvement of routinely collected patient satisfaction scores between intervention and control groups; Hanbury 2009 reported that the intervention did not significantly increase adherence among participants; Nielsen 2007 reported no statistically significant differences between the intervention and control groups; and Thompson 2000a reported that there were no differences between the intervention and control groups in relation to the recognition or treatment of patients with depression.

Although overall the results indicate some positive outcomes related to IPE, its effectiveness remains unclear at this time due to the heterogeneity among the 15 studies as well as their methodological limitations, as outlined above. The studies were heterogeneous in relation to the objectives and format of the educational intervention, the existence of other interventions in addition to the education, and the clinical areas and settings. The IPE component in these studies ranged from a few hours, to a few days, to longitudinal programmes that were delivered over one year or more. The professional mix of participants also varied from surgeons, nurses, surgical technicians, anaesthesiologists and physician assistants (Weaver 2010), to nurses, physiotherapists, occupational therapists, nursing assistants and maintenance staff (Rask 2007). The aims of the interventions also varied. For example in studies by Brown 1999 and Helitzer 2011, the emphasis was on communication between clinicians and participants, whereas other studies explicitly focused on interprofessional team work in the context of particular settings (ED, operation room) (e.g. Morey 2002; Weaver 2010).

Despite three studies sharing a focus on improving diabetes care (Barcelo 2010; Janson 2009; Taylor 2007), each employed a different research design: an RCT (Barcelo 2010), a CBA (Janson 2009) and an ITS (Taylor 2007). The interventions were different: from a single eight-hour IPE session (Barcelo 2010), to three workshops (Taylor 2007), to weekly seminars (Janson 2009). The participants also varied, from physicians, nurses, nutritionists and psychologists based at 10 public health centres (Barcelo 2010), to 120 students (medical residents, senior nurse practitioner and pharmacy students) (Janson 2009), to an existing team of professionals (who were not identified) based in a single clinic (Taylor 2007). These few examples are some indication of the degrees of heterogeneity and why it is difficult to summarise and identify key elements of successful IPE.

Eight of the studies (Barcelo 2010; Campbell 2001; Janson 2009; Morey 2002; Nielsen 2007; Rask 2007; Thompson 2000b; Young 2005) contained multi-faceted interventions, of which the IPE was only one component. The other interventions included team restructuring, tools such as posters and questionnaires, measurement and feedback, and consumer-directed interventions. In these studies, the authors commented on the importance of system change and the time and resources required to facilitate it (Campbell 2001), the need for leaders who support teamwork within organisations (Morey 2002; Rask 2007) and the use of quality improvement projects (Barcelo 2010; Janson 2009).

Methodologically, the studies shared a common key limitation. All comparative studies (RCTs and CBAs, n = 13) compared the effects of the IPE interventions with control groups that received no educational intervention. As a result, it is difficult to assess the effects of the IPE. Furthermore, most of the included studies involved small samples (defined as fewer than 100 individually randomised practitioners or fewer than 20 randomised clusters), which limited their ability to provide a convincing level of generalisable evidence for the effects of the IPE interventions.

It is also worth noting that there was little evidence of preliminary studies to optimise the IPE interventions and evaluation strategies. IPE interventions are complex, multifaceted interventions in which the components may act both independently and interdependently. Guidance on the development and testing of complex interventions stresses the importance of stepwise work to understand the context for the intervention fully, and optimise the design and implementation of the intervention and evaluation before proceeding to a trial (Craig 2008). 

When planning future trials of IPE, thought should be given to the following dimensions: better randomisation procedures, allocation concealment, larger sample sizes and more appropriate control groups. Importantly, studies should include at least one common outcome for measurement of teamwork to enable a formal weighing up of the evidence; in addition, the remainder of the outcomes should include a clear patient health outcome rather than only process measures. Given that IPE is delivered by two or more providers, future trials should have cluster randomised designs, and researchers are advised to be thoughtful about their unit of analysis. In addition, given a lack of evidence on the impact of IPE on resources (e.g. costs and benefits), attention is needed in this area.

While uniprofessional education remains the dominant model for delivering education for health and social care professionals, IPE is increasingly becoming common. Advocacy and implementation of IPE reflects the premise that IPE will contribute to developing healthcare providers with the skills and knowledge needed to work in a collaborative manner (Barr 2005; CIHC 2010; Interprofessional Educ Collab Expert Panel 2011; WHO 2010). Interprofessional collaboration, in turn, is identified as critical to the provision of effective and efficient health care, given the complexity of patients' healthcare needs and the range of healthcare providers and organisations. In relation to implementing IPE at differing stages of the professional development continuum, it is worth remembering that pre-qualification IPE can be regarded as an investment in the future and, in general, studies with short periods of follow-up would not be expected to detect effects on patient outcomes or healthcare processes, which would be difficult to pinpoint, due to a wide variety of potentially confounding variables. Measuring patient outcomes or care process outcomes arising from IPE after qualification (e.g. during continuing professional development and quality improvement initiatives) is more feasible. But it still presents methodological challenges, particularly identifying the influence of IPE within multifaceted interventions and, further, identifying key attributes of effective IPE.

Although this review located nine new IPE studies (which were added to the six studies from the last update) their heterogeneity limits the conclusions we can draw from this work. Nevertheless, a continued increase in eligible studies represents a further positive step forward in establishing a robust evidence base for the effects of IPE on professional practice and healthcare outcomes.

 

Authors' conclusions

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Index terms

 

Implications for practice

Our first IPE review published in 1999 found no eligible studies, our 2008 update located six studies, and this update located a further nine studies. At 15 eligible studies, this demonstrates that the IPE field is growing steadily in terms of publishing rigorous IPE research (those employing RCTs, CBA or ITS designs). Although these studies reported a range of positive outcomes, the heterogeneity of IPE interventions means it is not possible to draw generalisable inferences for the effects of IPE. Despite marking a step forward in beginning to establish an evidence base for IPE, more rigorous IPE research (those employing RCTs, CBA or ITS designs) is needed to demonstrate evidence of the impact of this type of intervention on professional practice or healthcare outcomes, or both.

 
Implications for research

Despite a growth of IPE studies in the past few years, most of this research does not employ rigorous designs. Future RCTs explicitly focused on IPE with rigorous randomisation procedures and allocation concealment, larger sample sizes and more appropriate control groups would improve the evidence base of IPE. A focus on understanding the use of IPE in relation to resources is also needed. These studies should also include data collection strategies that provide insight into how IPE affects changes in healthcare processes and patient outcomes as research to date has not sufficiently addressed this critical issue.  

To improve the quality of evidence relating to IPE and patient outcomes or healthcare process outcomes, the following three gaps will need to be filled: studies that assess the effectiveness of IPE interventions compared to separate, profession-specific interventions; RCT, CBA or ITS studies with qualitative strands examining processes relating to the IPE and practice changes; and cost-benefit analyses.

What’s new

We completed a substantive update of review from 2008 to 2011. Nine new studies were found and added to the six studies located from the previous update.

 

Acknowledgements

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Index terms

Amber Fitzsimmons, doctoral student at University of California, San Francisco, for her help with preliminary abstraction notes of some of the included studies.

 

Data and analyses

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Index terms

This review has no analyses.

 

Appendices

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Index terms
 

Appendix 1. MEDLINE search strategy

MEDLINE search strategy
1 (interprofession$ or inter-profession$).tw.

2 (interdisciplin$ or inter-disciplin$).tw.

3 (interoccupation$ or inter-occupation$).tw.

4 (interinstitut$ or inter-institut$).tw.

5 (interagen$ or inter-agen$).tw.

6 (intersector$ or inter-sector$).tw.

7 (interdepartment$ or inter-department$).tw.

8 (interorgani?ation$ or inter-organi?ation$).tw.

9 interprofessional relations/

10 team$.tw.

11 (multiprofession$ or multi-profession$).tw.

12 (multidisciplin$ or multi-disciplin$).tw.

13 (multiinstitution$ or multi-institution$).tw.

14 (multioccupation$ or multi-occupation$).tw.

15 (multiagenc$ or multi-agenc$).tw.

16 (multisector$ or multi-sector$).tw.

17 (multiorgani?ation$ or multi-organi?ation$).tw.

18 exp professional-patient relations/

19 (transprofession$ or trans-profession$).tw.

20 (transdisciplin$ or trans-disciplin$).tw

21 or/1-20

22 (education$ or train$ or learn$ or teach$ or course$).tw.

23 exp education, continuing/

24 exp education, graduate/

25 or/22-24

26 21 and 25

27 program evaluation/

28 "health care outcome?".tw.

29 (education$ adj outcome?).tw.

30 or/27-29

31 26 and 30

 

 

Appendix 2. CINAHL search strategy

CINAHL search strategy

(TX interprofession*) or (TX inter-profession*) or (TX interdisciplin*) or (TX inter-disciplin*) or (TX interoccupation*) or (TX inter-occupation*) or (TX interinstitut*) or (TX inter-institut*) or (TX interagen*) or (TX inter-agen*) or (TX intersector*) or (TX inter-sector*) or (TX interdepartment*) or (TX inter-department*) or (TX interorgani?ation*) or (TX inter-organi?ation*) or (MH interprofessional relations) or (TX team*) or (TX multiprofession*) or (TX multi-profession*) or (TX multidisciplin*) or (TX multi-disciplin*) or (TX multiinstitution*) or (TX multi-institution*) or (TX multioccupation*) or (TX multi-occupation*) or (TX multiagenc*) or (TX multi-agenc*) or (TX multisector*) or (TX multi-sector*) or (TX multiorgani?ation*) or (TX multi-organi?ation*) or (MH "Professional-Patient Relations+") or (TX transprofession*) or (TX trans-profession*) or (TX transdisciplin*) or (TX trans-disciplin*) AND (TX education*) or (TX train*) or (TX learn*) or (TX teach*) or (TX course*) or (MH "education, continuing+") or (MH "education, graduate+") AND (MH "student performance appraisal+") or (MH "course evaluation") or (MH "program evaluation") or (MH "evaluation research+") or (MH "health care outcome*") or (education* N1 outcome*)

 

Feedback

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Index terms
 

Lack of Evidence

 

Summary

Received 20/04/2003 13:47:02

I am assuming this excellent work is a follow up from earlier published material from 1999 (J. Int. Care 13 (4)417-4). What I cannot understand is why, therefore is IPE still 'flavour of the month'? We wouldn't push ideas forward without adequate evidence of effectiveness first! Isn't anyone else out there brave enough to concur with the authors? I certify that I have no affiliations with or involvement in any organisation or entity with a direct financial interest in the subject matter of my criticisms.

 

Reply

Thank you for your positive comment. The article to which you refer is indeed a print version of this Cochrane review, and we will note that in the review. We would like to stress that the 'absence of evidence of effect is not evidence of absence of effect' (Cochrane Reviewers' Handbook 4.1.5, section 9.7). We therefore suggest that interprofessional education (IPE) interventions ought to be implemented widely, but ONLY in the context of rigorous evaluations, ideally randomised controlled trials of their effects. This is not as difficult as it might at first seem, and we would encourage those who are interested enough in IPE to want to subject it to reliable test to contact us or other groups of researchers with randomised controlled trial experience for advice and help.

Merrick Zwarenstein [on behalf of the reviewers.]

The most recent update to this review is published in Issue 1, 2008. The update now has 6 studies. However, it still remains very difficult to draw conclusions about the effectiveness of this intervention and we continue to require further research in the area.

Alain Mayhew [on behalf of the authors and the editorial staff and team]

 

Contributors

Jane Warner, Practice Nurse

 

What's new

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Index terms

Last assessed as up-to-date: 3 August 2011.


DateEventDescription

28 February 2013New search has been performedSubstantive amendment, search up to Aug 2011, nine additonal studies

28 February 2013New citation required but conclusions have not changedNine new studies, but no change in conclusions



 

History

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Index terms

Protocol first published: Issue 3, 2000
Review first published: Issue 1, 2001


DateEventDescription

29 July 2008AmendedConverted to new review format.

12 November 2007New citation required and conclusions have changedSubstantive amendment



 

Contributions of authors

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Index terms

SR, LP and JG searched and reviewed the literature and extracted data with input from MZ. SR interpreted the data and wrote the main draft of the review with input from LP, JG, DF and MZ. MZ Is guarantor for the review.

 

Declarations of interest

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Index terms

None known.

 

Sources of support

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. Feedback
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Index terms
 

Internal sources

  • Center for Innovation in Interprofessional Education, University of California, San Francisco, USA.
  • Li Ka Shing Knowledge Institute of St Michael's Hospital, Canada.
  • Continuing Education and Professional Development, Faculty of Medicine, University of Toronto, Canada.
  • Institute of Health Sciences Education, Queen Mary University London, UK.
  • Institute for Clinical Effectiveness, Toronto, Canada.

 

External sources

  • No sources of support supplied

References

References to studies included in this review

  1. Top of page
  2. Abstract
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. Feedback
  14. What's new
  15. History
  16. Contributions of authors
  17. Declarations of interest
  18. Sources of support
  19. Characteristics of studies
  20. References to studies included in this review
  21. References to studies excluded from this review
  22. Additional references
  23. References to other published versions of this review
Barcelo 2010 {published data only}
  • Barcelo A, Cafiero E, de Boer M, Mesa AE, Lopez MG, Jimenez RA, et al. Using collaborative learning to improve diabetes care and outcomes: the VIDA project. Primary Care Diabetes 2010;4(3):145-53.
Brown 1999 {published data only}
  • Brown JB, Boles M, Mullooly JP, Levinson W. Effect of clinician communication skills training on patient satisfaction: a randomized controlled trial. Annals of Internal Medicine 1999;131(11):822-9.
Campbell 2001 {published data only}
Hanbury 2009 {published data only}
Helitzer 2011 {published data only}
  • Helitzer DL, Lanoue M, Wilson B, de Hernandez BU, Warner T, Roter D. A randomized controlled trial of communication training with primary care providers to improve patient-centeredness and health risk communication. Patient Education & Counseling 2011;82(1):21-9.
Janson 2009 {published data only}
  • Janson SL, Cooke M, McGrath KW, Kroon LA, Robinson S, Baron RB. Improving chronic care of type 2 diabetes using teams of interprofessional learners. Academic Medicine 2009;84(11):1540-8.
Morey 2002 {published data only}
Nielsen 2007 {published data only}
  • Nielsen PE, Goldman MB, Mann S, Shapiro DE, Marcus RG, Pratt SD, et al. Effects of teamwork training on adverse outcomes and process of care in labor and delivery: a randomized controlled trial. Obstetrics & Gynecology 2007;109(1):48-55.
Rask 2007 {published data only}
Strasser 2008 {published data only}
  • Strasser DC, Falconer JA, Stevens AB, Uomoto JM, Herrin J, Bowen SE, et al. Team training and stroke rehabilitation outcomes: a cluster randomized trial. Archives of Physical Medicine & Rehabilitation 2008;89(1):10-5.
Taylor 2007 {published data only}
  • Taylor CR, Hepworth JT, Buerhaus PI, Dittus R, Speroff T. Effect of crew resource management on diabetes care and patient outcomes in an inner-city primary care clinic. Quality & Safety in Health Care 2007;16(4):244-7.
Thompson 2000a {published data only}
  • Thompson C, Kinmonth AL, Stevens L, Peveler RC, Stevens A, Ostler KJ, et al. Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire depression project randomised controlled trial. Lancet 2000a;355(9199):185-91.
Thompson 2000b {published data only}
  • Thompson RS, Rivara FP, Thompson DC, Barlow WE, Sugg NK, Maiuro RD, et al. Identification and management of domestic violence: a randomized trial. American Journal of Preventive Medicine 2000b;19(4218):253-63.
Weaver 2010 {published data only}
  • Weaver SJ, Rosen MA, DiazGranados D, Lazzara EH, Lyons R, Salas E, et al. Does teamwork improve performance in the operating room? A multilevel evaluation. Joint Commission Journal on Quality & Patient Safety 2010;36(3):133-42.
Young 2005 {published data only}

References to studies excluded from this review

  1. Top of page
  2. Abstract
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. Feedback
  14. What's new
  15. History
  16. Contributions of authors
  17. Declarations of interest
  18. Sources of support
  19. Characteristics of studies
  20. References to studies included in this review
  21. References to studies excluded from this review
  22. Additional references
  23. References to other published versions of this review
Ammentorp 2007 {published data only}
  • Ammentorp J, Sabroe S, Kofoed PE, Mainz J. The effect of training in communication skills on medical doctors' and nurses' self-efficacy. A randomized controlled trial. Patient Education & Counseling 2007;66(3):270-7.
Anderson 2009 {published data only}
  • Anderson ES, Lennox A. The Leicester Model of Interprofessional education: developing, delivering and learning from student voices for 10 years. Journal of Interprofessional Care 2009;23(6):557-73.
Antunez 2003 {published data only}
Armitage 2009 {published data only}
  • Armitage H, Pitt R, Jinks A. Initial findings from the TUILIP (Trent Universities Interprofessional Learning in Practice) project. Journal of Interprofessional Care 2009;23(1):101-3.
Barrett 2001 {published data only}
  • Barrett J, Gifford C, Morey J, Risser D, Salisbury M. Enhancing patient safety through teamwork training. Journal of Healthcare Risk Management 2001;21(4):57-65.
Barton 2006 {published data only}
  • Barton C, Miller B, Yaffe K. Improved evaluation and management of cognitive impairment: results of a comprehensive intervention in long-term care [see comment]. Journal of the American Medical Directors Association 2006;7(2):84-9.
Bashir 2000 {published data only}
  • Bashir K, Blizard B, Bosanquet A, Bosanquet N, Mann A, Jenkins R. The evaluation of a mental health facilitator in general practice: effects on recognition, management, and outcome of mental illness. British Journal of General Practice 2000;50(457123):626-9.
Bauer 2009 {published data only}
  • Bauer G, Bossi L, Santoalla M, Rodriguez S, Farina D, Speranza AM. [Impact of a respiratory disease prevention program in high-risk preterm infants: a prospective, multicentric study]. Archivos Argentinos de Pediatria 2009;107(2):111-8.
Beal 2006 {published data only}
  • Beal T, Kemper K J, Gardiner P, Woods C. Long-term impact of four different strategies for delivering an on-line curriculum about herbs and other dietary supplements. BMC Medical Education 2006;6:39.
Belardi 2004 {published data only}
  • Belardi FG, Weir S, Craig FW. A controlled trial of an advanced access appointment system in a residency family medicine center. Family Medicine 2004;36(5):341-5.
Bell 2000 {published data only}
  • Bell CM, Ma M, Campbell S, Basnett I, Pollock A, Taylor I. Methodological issues in the use of guidelines and audit to improve clinical effectiveness in breast cancer in one United Kingdom health region. European Journal of Surgical Oncology 2000;26(2):130-6.
Bellamy 2006 {published data only}
  • Bellamy A, Fiddian M, Nixon J. Case reviews: promoting shared learning and collaborative practice. International Journal of Palliative Nursing 2006;12(4):158-62.
Benjamin 1999 {published data only}
  • Benjamin EM, Schneider MS, Hinchey KT. Implementing practice guidelines for diabetes care using problem-based learning: a prospective controlled trial using firm systems. Diabetes Care 1999;22(1019):1672-8.
Berg 2009 {published data only}
  • Berg BW, Sampaga A, Garshnek V, Hara KM, Phrampus PA. Simulation crisis team training effect on rural hospital safety climate (SimCritter). Hawaii Medical Journal 2009;68(10):253-5.
Berggren 2008 {published data only}
  • Berggren M, Stenvall M, Olofsson B, Gustafson Y. Evaluation of a fall-prevention program in older people after femoral neck fracture: a one-year follow-up. Osteoporosis International 2008;19(6):801-9.
Birch 2007 {published data only}
Bluespruce 2001 {published data only}
Boyle 2004 {published data only}
Bradshaw 2011 {published data only}
  • Bradshaw LM, Gergar ME, Holko GA. Collaboration in wound photography competency development: a unique approach. Advances in Skin & Wound Care 2011;24(2):85-92.
Buck 1999 {published data only}
  • Buck MM, Tilson ER, Andersen JC. Implementation and evaluation of an interdisciplinary health professions core curriculum. Journal of Allied Health 1999;28(3):174-8.
Burns 2003 {published data only}
  • Burns JP, Mello MM, Studdert DM, Puopolo AL, Truog RD, Brennan TA. Results of a clinical trial on care improvement for the critically ill. Critical Care Medicine 2003;31(8):2107-17.
Buxton 2004 {published data only}
  • Buxton L, Pidduck D, Marston G, Perry D. Development of a multidisciplinary care pathway for a specialist learning disability inpatient treatment and assessment unit. Journal of Integrated Care Pathways 2004;8(3):119-26.
Cameron 2009 {published data only}
  • Cameron TS, McKinstry A, Burt SK, Howard ME, Bellomo R, Brown DJ, et al. Outcomes of patients with spinal cord injury before and after introduction of an interdisciplinary tracheostomy team. Critical Care & Resuscitation 2009;11(1):14-9.
Carew 2001 {published data only}
  • Carew LB, Chamberlain VM. Interdisciplinary update nutrition course offered to educators through interactive television. Journal of Nutrition Education 2001;33(6):352-3.
Cobia 1995 {published data only}
Coggrave 2001 {published data only}
  • Coggrave M. Care of the ventilator dependent spinal cord-injured patient. British Journal of Therapy & Rehabilitation 2001;8(4):146-9.
Connolly 1995 {published data only}
  • Connolly PM. Transdisciplinary collaboration of academia and practice in the area of serious mental illness. Australian & New Zealand Journal of Mental Health Nursing 1995;4(4):168-80. [MEDLINE: 97241876]
Cooper 2005 {published data only}
  • Cooper H, Spencer-Dawe E, McLean E. Beginning the process of teamwork: design, implementation and evaluation of an inter-professional education intervention for first year undergraduate students. Journal of Interprofessional Care 2005;19(5):492-508.
Corso 2006 {published data only}
  • Corso R, Brekken L, Ducey C, KnappPhilo J. Professional development strategies to support the inclusion of infants and toddlers with disabilities in infant-family programs. Zero to Three 2006;26(3):36-42.
Crutcher 2004 {published data only}
Dacey 2010 {published data only}
  • Dacey M, Murphy JI, Anderson DC, McCloskey WW. An interprofessional service-learning course: uniting students across educational levels and promoting patient-centered care. Journal of Nursing Education 2010;49(12):696-9.
Dalton 1999 {published data only}
  • Dalton JA, Blau W, Lindley C, Carlson J, Youngblood R, Greer SM. Changing acute pain management to improve patient outcomes: an educational approach. Journal of Pain and Symptom Management 1999;17(4):277-87.
DeVita 2005 {published data only}
  • DeVita, Schaefer J, Lutz J, Wang H, Dongilli T. Improving medical emergency team (MET) performance using a novel curriculum and a computerized human patient stimulator. Quality & Safety in Health Care 2005;14(5):326-31.
Dienst 1981 {published data only}
  • Dienst ER, Byl N. Evaluation of an educational program in health care teams. Journal of Community Health 1981;6(4):282-98. [MEDLINE: 82120622]
Dobson 2002 {published data only}
  • Dobson S, Upadhyaya S, Stanley B. Using an interdisciplinary approach to training to develop the quality of communication with adults with profound learning disabilities by care staff. International Journal of Language & Communication Disorders 2002;37(1):41-57.
Falconer 1993 {published data only}
  • Falconer JA, Roth EJ, Sutin JA, Strasser DC, Chang RW. The critical path method in stroke rehabilitation: lessons from an experiment in cost containment and outcome improvement. Quality Review Bulletin 1993;19(1):8-16. [MEDLINE: 93205371]
Fields 2005 {published data only}
  • Fields M, Peterman J. Intravenous medication safety system averts high-risk medication errors and provides actionable data. Nursing Administration Quarterly 2005;29(1):78-87.
Gandara 2010 {published data only}
  • Gandara E, Ungar J, Lee J, Chan-Macrae M, O'Malley T, Schnipper JL. Discharge documentation of patients discharged to subacute facilities: a three-year quality improvement process across an integrated health care system. Joint Commission Journal on Quality & Patient Safety 2010;36(6):243-51.
Hanson 2005 {published data only}
  • Hanson LC, Reynolds KS, Henderson M, Pickard CG. A quality improvement intervention to increase palliative care in nursing homes. Journal of Palliative Medicine 2005;8(3):576-84.
Harmon 1998 {published data only}
Hayward 1996 {published data only}
  • Hayward KS, Powell LT, McRoberts J. Changes in student perceptions of interdisciplinary practice in the rural setting. Journal of Allied Health 1996;25(4):315-27. [MEDLINE: 97137480]
Hien 2008 {published data only}
  • Hien le TT, Takano T, Seino K, Ohnishi M, Nakamura K. Effectiveness of a capacity-building program for community leaders in a healthy living environment: a randomized community-based intervention in rural Vietnam. Health Promotion International 2008;23(4):354-64.
Hook 2003 {published data only}
Hope 2005 {published data only}
  • Hope JM, Lugassy D, Meyer R, Jeanty F, Myers S, Jones S, et al. Bringing interdisciplinary and multicultural team building to health care education: the downstate team-building initiative. Academic Medicine 2005;80(1):74-83.
Horbar 2001 {published data only}
  • Horbar JD, Rogowski J, Plsek PE, Delmore P, Edwards WH, Hocker J, et al. Collaborative quality improvement for neonatal intensive care. NIC/Q project investigators of the Vermont Oxford Network. Pediatrics 2001;107(1383):14-22.
Hughes 2000 {published data only}
  • Hughes TL, Medina Walpole AM. Implementation of an interdisciplinary behavior management program. Journal of the American Geriatrics Society 2000;48(5):581-7.
James 2005 {published data only}
  • James R, Barker J. Evaluation of a model of interprofessional education. Nursing Times 2005;101(40):34-6.
Jones 2006 {published data only}
Jordan-Marsh 2004 {published data only}
  • Jordan-Marsh M, Hubbard J, Watson R, Deon Hall R, Miller P, Mohan O. The social ecology of changing pain management: do I have to cry?. Journal of Pediatric Nursing 2004;19(3):193-203.
Kenward 2009 {published data only}
  • Kenward L, Stiles M. Intermediate care: an interprofessional education opportunity in primary care. Journal of Interprofessional Care 2009;23(6):668-71.
Ketola 2000 {published data only}
Kwan 2006 {published data only}
  • Kwan D, Barker KK, Austin Z, Chatalalsingh C, Grdisa V, Langlois S, et al. Effectiveness of a faculty development program on interprofessional education: a randomized controlled trial. Journal of Interprofessional Care 2006;20(3):314-6.
Landon 2004 {published data only}
  • Landon BE, Wilson IB, McInnes K, Landrum MB, Hirschhorn L, Marsden PV, et al. Improving patient care: effects of a quality improvement collaborative on the outcome of care of patients with HIV infection: the EQHIV study. Annals of Internal Medicine 2004;140(11):887-96.
Lawrence 2002 {published data only}
  • Lawrence SJ, Shadel BN, Leet TL, Hall JB, Mundy LM. An intervention to improve antibiotic delivery and sputum procurement in patients hospitalized with community-acquired pneumonia. Chest 2002;122(3):913-9.
Lia-Hoagberg 1997 {published data only}
  • Lia-Hoagberg B, Nelson P, Chase RA. An interdisciplinary health team training program for school staff in Minnesota. Journal of School Health 1997;67(3):94-7. [MEDLINE: 97225297]
Llewellyn-Jones 1999 {published data only}
  • Llewellyn-Jones RH, Baikie KA, Smithers H, Cohen J, Snowdon J, Tennant CC. Multifaceted shared care intervention for late life depression in residential care: randomised controlled trial. BMJ 1999;319(7211174):676-82.
McBride 2000 {published data only}
  • McBride P, Underbakke G, Plane MB, Massoth K, Brown R, Solberg LI, et al. Improving prevention systems in primary care practices: the health education and research trial (HEART). Journal of Family Practice 2000;49(2707):115-25.
Monette 2008 {published data only}
  • Monette J, Champoux N, Monette M, Fournier L, Wolfson C, du Fort GG, et al. Effect of an interdisciplinary educational program on antipsychotic prescribing among nursing home residents with dementia. International Journal of Geriatric Psychiatry 2008;23(6):574-9.
Nash 1993 {published data only}
  • Nash A, Hoy A. Terminal care in the community - an evaluation of residential workshops for general practitioner/district nurse teams. Palliative Medicine 1993;7(1):5-17. [MEDLINE: 94115720]
O'Boyle 1995 {published data only}
Olivecrona 2010 {published data only}
  • Olivecrona C, Karrlander S, Hylin U, Tornkvist H, Jonsson C, Svensen C. [A successful educational program for medical and nursing students. Interprofessional learning gives insights and strengthens team work]. Lakartidningen 2010;107(3):113-5.
Ouslander 2001 {published data only}
  • Ouslander JG, Maloney C, Grasela TH, Rogers L, Walawander CA. Implementation of a nursing home urinary incontinence management program with and without tolterodine. Journal of the American Medical Directors Association 2001;2(5):207-14.
Phillips 2002 {published data only}
  • Phillips M, Givens C, Schreiner B. Put into practice: impact of a multidisciplinary education program for children and adolescents with type 2 diabetes. Diabetes Educator 2002;28(3):400-2.
Price 2005 {published data only}
  • Price D, Howard M, Shaw E, Zazulak J, Waters H, Chan D. Family medicine obstetrics: collaborative interdisciplinary program for a declining resource. Canadian Family Physician 2005;51:68-74.
Rogowski 2001 {published data only}
  • Rogowski JA, Horbar JD, Plsek PE, Baker LS, Deterding J, Edwards WH, et al. Economic implications of neonatal intensive care unit collaborative quality improvement. Pediatrics 2001;107(1384):23-9.
Rubenstein 1999 {published data only}
  • Rubenstein LV, Jackson-Triche M, Unutzer J, Miranda J, Minnium K, Pearson ML, et al. Evidence-based care for depression in managed primary care practices. Health Affairs 1999;18(5439):89-105.
Ryan 2002 {published data only}
  • Ryan A, Carter J, Lucas J, Berger J. You need not make the journey alone: overcoming impediments to providing palliative care in a public urban teaching hospital. American Journal of Hospice and Palliative Care 2002;19(3):171-80.
Sauer 2010 {published data only}
  • Sauer J, Darioly A, Mast MS, Schmid PC, Bischof N. A multi-level approach of evaluating crew resource management training: a laboratory-based study examining communication skills as a function of team congruence. Ergonomics 2010;53(11):1311-24.
Smarr 2003 {published data only}
  • Smarr KL. The effects of arthritis professional continuing education in vocational rehabilitation [unpublished Ph.D.]. University of Missouri, Columbia 2003.
Smith 2005 {published data only}
  • Smith C, Rebeck S, Schaag H, Kleinbeck S, Moore JM, Bleich MR. A model for evaluating systemic change: measuring outcomes of hospital discharge education redesign. Journal of Nursing Administration 2005;35(2):67-73.
Stewart 2010 {published data only}
  • Stewart EE, Nutting PA, Crabtree BF, Stange KC, Miller WL, Jaen CR. Implementing the patient-centered medical home: observation and description of the national demonstration project. Annals of Family Medicine 2010;8 Suppl 1:S21-32.
Taylor 2002 {published data only}
  • Taylor BL, Smith GB. Trainees' views of a multidisciplinary training programme in intensive care medicine. Care of the Critically Ill 2002;18(5):148-51.
Thomas 2007 {published data only}
  • Thomas EJ, Taggart B, Crandell S, Lasky RE, Williams AL, Love LJ, et al. Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial. Journal of Perinatology 2007;27(7):409-14.
Trummer 2006 {published data only}
  • Trummer UF, Mueller UO, Nowak P, Stidl T, Pelikan JM. Does physician-patient communication that aims at empowering patients improve clinical outcome? A case study. Patient Education & Counseling 2006;61(2):299-306.
Tschopp 2005 {published data only}
  • Tschopp JM, Frey JG, Janssens JP, Burrus C, Garrone S, Pernet R, et al. Asthma outpatient education by multiple implementation strategy: outcome of a programme using a personal notebook. Respiratory Medicine 2005;99(3):355-62.
Umble 2003 {published data only}
  • Umble KE, Shay S, Sollecito W. An interdisciplinary MPH via distance learning: meeting the educational needs of practitioners. Journal of Public Health Management and Practice 2003;9(2):123-35.
Unutzer 2001 {published data only}
  • Unutzer J, Rubenstein L, Katon WJ, Tang L, Duan N, Lagomasino IT, et al. Two-year effects of quality improvement programs on medication management for depression. Archives of General Psychiatry 2001;58(10233):935-42.
Ward 2004 {published data only}
  • Ward C, Wright M. Fast-track palliative care training to bridge the theory-practice gap. Nursing Times 2004;100(12):38-40.
Wells 2000 {published data only}
  • Wells K, Sherbourne C, Schoenbaum M, Duan N, Meredith L, Unutzer J, et al. Impact of disseminating quality improvement programs for depression in managed primary care: a randomized controlled trial. JAMA 2000;283(2176):212-20.
Westfelt 2010 {published data only}
  • Westfelt P, Hedskold M, Pukk-Harenstam K, Svensson R M, Wallin C J. [Efficient training in cooperation within your own emergency department. With patient simulation and skilled trainers]. Lakartidningen 2010;107(10):685-9.
Wisborg 2009 {published data only}
  • Wisborg T, Brattebo G, Brinchmann-Hansen A, Hansen K S. Mannequin or standardized patient: participants' assessment of two training modalities in trauma team simulation. Scandinavian Journal of Trauma, Resuscitation & Emergency Medicine 2009;17:59.

Additional references

  1. Top of page
  2. Abstract
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. Feedback
  14. What's new
  15. History
  16. Contributions of authors
  17. Declarations of interest
  18. Sources of support
  19. Characteristics of studies
  20. References to studies included in this review
  21. References to studies excluded from this review
  22. Additional references
  23. References to other published versions of this review
Barr 2005
  • Barr H, Koppel I, Reeves S, Hammick M, Freeth D. Effective interprofessional education: assumption, argument and evidence. London: Blackwell, 2005.
Berridge 2010
  • Berridge EJ, Mackintosh N, Freeth D. Supporting patient safety: examining communication within delivery suite teams through contrasting approaches to research observation. Midwifery 2010;26:512-9.
Charles Campion-Smith 2011
  • Campion-Smith C, Austin H, Criswick S, Dowling B, Francis G. Can sharing stories change practice? A qualitative study of an interprofessional narrative-based palliative care course. Journal of Interprofessional Care 2011;25:105–11.
CIHC 2010
  • Canadian Interprofessional Health Collaboration. A national interprofessional competency framework, 2010. www.cihc.ca/files/CIHC_IPCompetencies_Feb1210.pdf. Vancouver, B.C.: Canadian Interprofessional Health Collaboration, (accessed 18 February 2013).
Craig 2008
  • Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M, Guidance, MRC. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008;337:a1655.
Frenk 2010
Interprofessional Educ Collab Expert Panel 2011
  • Interprofessional Education Collaborative Expert Panel. Core competencies for interprofessional collaborative practice: Report of an expert panel, 2011. www.aacp.org/resources/education/Documents/10-242IPECFullReportfinal.pdf. Washington, D.C.: Interprofessional Education Collaborative, (accessed 18 February 2013).
Makowsky 2009
  • Makowsky M, Schindel T, Rosenthal M, Campbell K, Tsuyuki R, Madill H. Collaboration between pharmacists, physicians and nurse practitioners: a qualitative investigation of working relationships in the inpatient medical setting. Journal of Interprofessional Care 2009;23(2):169-84.
Reeves 2008
Reeves 2010
  • Reeves S, Lewin S, Espin S, Zwarenstein M. Interprofessional Teamwork for Health and Social Care. London: Blackwell-Wiley, 2010.
Sargeant 2011
Suter 2012
WHO 2010
  • World Health Organization. Framework for action on interprofessional education and collaborative practice, 2010. whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf (accessed 18 February 2013). [: WHO reference number: WHO/HRH/HPN/10.3.]

References to other published versions of this review

  1. Top of page
  2. Abstract
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. Feedback
  14. What's new
  15. History
  16. Contributions of authors
  17. Declarations of interest
  18. Sources of support
  19. Characteristics of studies
  20. References to studies included in this review
  21. References to studies excluded from this review
  22. Additional references
  23. References to other published versions of this review
Zwarenstein 2000
Zwarenstein 2009