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Share this article Share with email Share with twitter Share with linkedin Share with facebook. Abstract The Interprofessional Rural Program of British Columbia IRPbc was established in as an important first step for the Province of British Columbia, Canada, in creating a collaborative interprofessional education initiative that engages numerous communities, health authorities and post-secondary institutions in working toward a common goal.
Designed to foster interprofessional education and promote rural recruitment of health professionals, the program places teams of students from a number of health professional programs into rural and remote British Columbia communities. In addition to meeting their discipline specific learning objectives, the student teams are provided with the opportunity to experience the challenges of rural life and practice and advance their interprofessional competence.
Multiple methods were used to gather the information for this report including individual and group interviews with program participants, debriefing sessions with students at the end of each phase, and a self-reporting system for the participating community professionals. Partner members were also interviewed. The evaluation team was unable to locate within the professional and academic literature existing measures that would have provided the accuracy needed to measure the desired outcomes.
We therefore chose to use a qualitative approach to evaluation. We also used a formative method of evaluation in order to create a continuous feedback loop throughout the various phases. We wanted to facilitate improvements in the program as information became available. Indeed, the process evaluation method chosen turned out to be a plus in terms of being able to make immediate improvements to the program as we progressed through each subsequent phase.
The struggles and benefits summarized in the following sections are based upon the opinions of the people interviewed and surveyed to date. Struggles Perhaps the greatest accomplishment of IRPbc, and one of the largest struggles, was bringing together the large numbers of partners that were needed to make the program a success. Fortunately, there had been a long-standing history through the BCAHC and a predecessor organization of many of the players coming together for collaborative initiatives across health and education.
A level of trust in collaborative process, quality output and partnerships among many individuals on the implementation team already existed. The challenge was to develop trust with, and ultimately achieve commitment from, a broader set of provincial partners not directly involved with the Implementation Team.
Creating a provincial program that respected traditional professional and post-secondary territories was challenging. As mentioned earlier, the short implementation timeframe for phase one, which was linked to funding requirements, presented the implementation team with some interesting logistical issues especially because of the geographic dispersion of the team members. It meant that the implementation team had to engage in rapid, constructive problem-solving.
To do this, the team initially met each month with those members from the rural communities attending by teleconference. Currently, all of the team members meet face to face twice a year for planning sessions. This is a costly endeavor but considered critical for the success of the program. Students were also included in these planning forums.
A number of potential post-secondary partners were excluded from the program due to scheduling difficulties. In addition, while it was highly desirable to include medical students in the IRPbc program, there were a number of obstacles. To compensate for some of the barriers, faculty members in the medical program were asked to assist with communication with their students. This resulted in an increase in the number of medical students participating in the program.
There were two primary drivers behind the program. One was the need to positively influence recruitment of health care professionals to rural communities. The other was to educate students about rural practice using interprofessional education and collaborative practice as the anchor. The selection of students needed to balance community needs, profession specific learning objectives, and prior experiences of students in relation to rural living.
Given this complex scenario, and diverse opinions about urban versus rural students most benefiting from IRPbc, there were times during program implementation when the placement-student match became contentious.
The timing of the team placements created significant challenges for the program. The health care post-secondary programs place students at different times of the year and for different lengths of time.
For example, nursing education is provided at several post- secondary institutions in the province and typically practica are staggered throughout the year to minimize the impact on the clinical community during heavy vacation times.
Scheduling challenges lead to the exclusion of certain programs from IRPbc because of the need to ensure that the widest range of disciplines were included in the program at any given time. The logistical challenge of creating a comprehensive team of students for a minimum of four weeks also excluded some programs.
Scheduling of the student orientation presented another challenge. With multiple schedules across programs, institutions and professions, there was no time when all the students could attend. Because of the tight timetable for medical students, they were the ones least likely to be able to attend the full orientation.
Travel distance for students, along with housing needs, added cost to the program and increased the difficulties associated with orientation scheduling. The tensions between demands placed on students by both their disciplines and the program created some difficulties. A common example was the difficulty that nursing students faced attending regular team meetings because they had worked a night shift just prior to the meeting.
To their credit, none of the students missed their team meetings although all went without sleep to do so. Benefits Despite logistical barriers and challenges, IRPbc realized many benefits. Students, preceptors, communities and post-secondary education institutions all cited positive experiences and outcomes.
The following section highlights the benefits of IRPbc. A number of benefits were identified through the evaluation process. The program expanded the practice education opportunities for students across a number of professions by creating new supervised practice opportunities for health professions. New preceptors were also recruited and trained, providing them with a new continuing professional development opportunity, confidence that they could supervise students, and a chance to participate in a new and exciting program.
These two benefits are helping to address current practica shortages experienced by many professional programs across the province. Each phase of the program has increased the number of post-secondary institutions, health professions and communities as new partners continue to join IRPbc. By regularly interacting with people in the community in a way not always possible in larger centers, students came away with a strong understanding about how the health of people is influenced by such factors as employment, housing, education and culture.
The students consistently reported that they also benefited from the opportunity to participate in the full continuum of care in a way not possible in urban placements which tend to be more specialized. The rural placements offered students the chance to be involved in prevention, home and community care, acute and long term settings representing a much broader learning experience.
The students also appeared to have contributed to the well-being of the communities in which they were placed. Not only did they provide additional services to the communities during the IRPbc program, but each of the 12 teams also completed community projects. The projects varied widely and frequently included the development of health promotional materials for use by community members.
In addition, many of the students were involved in the dissemination of information regarding the program and interprofessional practice. Another benefit of the program appears to have been an increase in community capacity through the inclusion of local professions in the planning and implementation of all components of the program. A wide range of health professionals in each of the communities was involved on the implementation team, and participated in planning sessions, orientation sessions, poster presentations at an international conference and evaluation.
The program also strengthened the working relationship between the communities and post-secondary institutions. The communities learned first hand about the constraints of post-secondary education and the complexities of practice education.
In turn the post-secondary education institutions learned about the challenges and opportunities afforded students and practitioners in rural communities. IRPbc communities have reported a number of positive changes within their health care services through the interaction with the students. For example, a number of preceptors believe that their involvement in the program has improved their collaboration with and understanding of their colleagues in their work settings. In addition, one of the communities has initiated and received funding for a primary care project in order to promote greater integration across the continuum of care, in part, due to their involvement in the program.
Other communities have held half or full day meetings involving students and practitioners to discuss opportunities for interprofessional collaboration. An important benefit of IRPbc has been the recruitment of participants to employment positions in rural communities upon graduation from their programs. The participating communities have hired former IRPbc students from nursing, social work, speech language, pharmacy and a medical laboratory.
In addition, a number of the participants have reported that they intend to return to rural practice after further consolidating their skills in urban centers. Lessons learned There are several success indicators associated with IRPbc. These relate to students, preceptors, communities and post-secondary education institutions and include the following:.
The selection of senior level students as program participants meant that they were able to have a better understanding of their own profession and that they were able to contribute in a meaningful way to their teams and the rural health services.
The student orientation served to inform the students of local issues and conditions and also was an important first step in team bonding. Community projects focused the students on an issue important to the community and created the most structured context for interprofessional collaboration.
Weekly projects, meetings and shadowing, as well as the student and preceptor orientations were valuable. The opportunity to live together facilitated team bonding and joint learning.
In the few instances where a team member did not live with the others, the students noted that they did not have the opportunity to share stories, continue case presentations, and generally get to know one another at a social level.
Interprofessional Rural Programme of BC Close collaboration among all of the systems represented in the program created opportunities for further collaboration on other interprofessional projects currently being launched. Provincial co-ordination offered by the British Columbia Academic Health Council was essential given the number of partners and conflicting needs and interests of the stakeholders.
Involvement of the broader community and media was important as was the opportunity for the students to participate in local events. Funding to offset some of the costs for students helped to make rural placements an attractive option for placement. Accommodation provided for students helped to further offset costs and, as mentioned previously, enhanced the interprofessional learning experience.
Post-secondary education institutions developed new relationships with rural commu- nities and by doing so, increase placement opportunities for students. Communities can create a dynamic and rewarding student experience that will encourage graduates to seek employment in rural communities.
The IRPbc model can be used as an effective strategy for developing interprofessional team skills and collaborative practice habits in students during pre-licensure education.
Conclusions IRPbc appears to have benefited students, practitioners, communities and post-secondary institutions. It also creates mechanisms and opportunities for collaboration among government, health authorities, post-secondary institutions and communities. It has provided a model for the implementation of interprofessional education and collaborative practice, thus creating a mechanism for positive change.
In doing so, it addresses recruitment, retention, and interprofessional health and human service education. References Barr, H. Ends and means in interprofessional education: towards a typology.
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