Interprofessional Training in a Psychiatric Study Unit
Condition: Interdisciplinary Communication
Study type: Interventional

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

Detailed description: 
      Research question and basic idea:

      Interprofessional collaboration is a skill that many health professionals need to develop.
      Interprofessional training offers a way to improve collaboration and patient care. The
      increasing number of psychiatric patients with complex needs, requires mental healthcare
      providers to enhance their skills. It necessitates that healthcare professionals collaborate
      effectively; nevertheless, many have not been trained in an interprofessional environment.
      Health professionals lack sufficient knowledge of other professional roles and competences to
      engage in teamwork. Interprofessional study units have been designed to create an optimal
      learning environment for healthcare students. These study units provide a new environment for
      learning, where students can learn from each other and develop competence in
      interprofessional collaboration. This collaboration gives students from several health
      professions an opportunity to achieve a greater understanding of the overall picture of the
      patient´s life. The limited data available suggest interprofessional collaboration
      interventions can improve health-care processes and outcomes; however, better designed
      studies are needed.

      Objective: Therefore, we will investigate whether placement at a psychiatric training unit
      compared with placement at a standard psychiatric ward improves students' interprofessional
      skills and patients' health status and satisfaction.

      Methods Design We designed a non-randomized intervention study with an intervention group
      (interprofessional training unit) and a comparison group (conventional inpatient ward).
      Patients were included in the period October 2016 - March 2018. The two wards were comparable
      in terms patient categories (psychiatric diagnoses), and the size, staffing and design of
      wards (17 single-bed rooms in each ward). Students in the intervention group receive
      interprofessional training in the training unit in Slagelse (SL3), while students in the
      comparison group receive conventional training in a standard wards (SL2,SL4,SL5). The
      intervention is an interprofessional clinical training unit including students from nursing,
      medicine, psychology, social work and nursing assistants.

      Questionnaires were administered to both groups at the beginning (T1) and end of
      hospitalization (T2).

      Sample size and feasibility:

      We powered the trial at 80% (α=0.05) to detect an effect size of 0.4, which we regarded as
      reasonable for determining clinically meaningful differences between interventions. Based on
      the power calculation we needed 120 patients per group Likewise, we conducted a power
      calculation regarding the students based on findings in a cross-sectional study. We used the
      students' interprofessional skills as the primary outcome. In the cross-sectional study the
      students had a mean score (RIPLS) of 69.98 (SD 25.5). When the sample size was calculated, 70
      students were needed in both the intervention and the control group. 82 students have
      clinical placement in the psychiatric study unit in Slagelse annually (SL3) and 67 students
      have clinical placement in the standard psychiatric wards (SL2, SL4 and SL5). Therefore, it
      seems realistic to include 190 students within 18 months.

      Participants:

      Students taking part in their clinical placement in Psychiatry West in Slagelse. Primarily
      including students from Nursing, in their 3rd year clinical placement, graduate medical
      students 4th term, clinical placement in psychiatry and nursing assistants in their 2nd year
      clinical placement. Students from the intervention group are similar to the comparison group
      in terms of stage of education and duration of clinical training.

      Inpatients aged 18-65 suffering from psychiatric disorders such as schizophrenia, psychosis,
      major depression, bipolar disorder, or severe personality disorder, and admitted October 2016
      - March 2018, were included.

      Allocation and recruitment:

      After primary admission in the emergency ward, the patients were referred to inpatient wards
      based on their home address.

      Students in both groups are allocated by program coordinators and supervisors from the
      involved university and colleges (University of Copenhagen, University College Zealand and
      Social and Healthcare College Zealand). The supervisors are responsible for the two groups of
      students and provided lists of names.

      Data were entered into the EasyTrial © online Clinical Trial Management system. Data were
      labelled with unique identifiers, and all personal identifiers were removed or disguised
      during analysis to preclude personal identification.

      Intervention:

      In 2015, Psychiatry in Slagelse established an interprofessional clinical training unit. The
      aim was to create a new environment for learning, where students could learn from each other
      and develop competence in interprofessional collaboration. In the training unit there are
      more students than in the other standard psychiatric wards and several professions are
      included.

      A facilitator team is responsible for the interprofessional training. In autumn 2016 seven
      professionals participate in course of facilitating interprofessional collaboration and
      training. The intervention involved the total staff participation in an initial eight-hour
      interactive workshop on the subject.

      The training unit is based on two educational interventions: Student participation in
      clinical care teams and interprofessional group tuition sessions.

      Clinical care team:

      The interprofessional clinical care team ensures that the patient pathways are well-planned
      and well-coordinated. Professionals included in the patient's care are part of the team
      alongside with the patient and their relatives. In the training unit the students are also
      part of the team. The team meets weekly. The team conference is an important
      interdisciplinary element in support of patient care during hospitalization. This is very
      important as patients' needs are often complex.

      Interprofessional group tuition:

      Interprofessional group tuition is a method to improve professional reflection on clinical
      practice. Patients in the training unit and their treatment and care are in focus. The group
      tuition takes an entire day with a mixture of theory and patient cases, in which all
      professional groups of students participate. The supervisors are responsible for planning the
      sessions.

      Ethical considerations:

      The study is licensed by the Danish Data Protection Agency (2008-58-0020) and needed no
      further ethical approval according to Danish legislation (16-000014). Data is anonymized and
      stored in a secure server. Students and patients will be informed about the project and its
      purpose immediately before participation. The return of questionnaires will be considered
      consent to participation.

      Time schedule:

      Data collection is started October 2016 and will run for 18 months. Data analysis will start
      January 2018. Publications are planned for 2018. The PhD study is scheduled for 3 years and
      will end on 31 March 2019.
    

Intervention name(s): Interprofessional clinical training unit
Intervention type(s): Other
Intervention description(s): In 2015, Psychiatry in Slagelse established an interprofessional clinical training unit. The aim was to create a new environment for learning, where students could learn from each other and develop competence in interprofessional collaboration. In the training unit there are more students than in the other standard psychiatric wards and several professions are included.
A facilitator team is responsible for the interprofessional training. In autumn 2016 seven professionals participate in course of facilitating interprofessional collaboration and training. The intervention involved the total staff participation in an initial workshop.
The training unit is based on two educational interventions: Student participation in clinical care teams and interprofessional group tuition sessions.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Interprofessional education; Training unit; Psychiatry; Patient reported outcome