Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland.
BMC Med Educ. 2024 Jun 4;24(1):615. doi: 10.1186/s12909-024-05590-0.
It has been difficult to demonstrate that interprofessional education (IPE) and interprofessional collaboration (IPC) have positive effects on patient care quality, cost effectiveness of patient care, and healthcare provider satisfaction. Here we propose a detailed explanation for this difficulty based on an adjusted theory about cause and effect in the field of IPE and IPC by asking: 1) What are the critical weaknesses of the causal models predominantly used which link IPE with IPC, and IPE and IPC with final outcomes? 2) What would a more precise causal model look like? 3) Can the proposed novel model help us better understand the challenges of IPE and IPC outcome evaluations? In the format of a critical theoretical discussion, based on a critical appraisal of the literature, we first reason that a monocausal, IPE-biased view on IPC and IPC outcomes does not form a sufficient foundation for proper IPE and IPC outcome evaluations; rather, interprofessional organization (IPO) has to be considered an additional necessary cause for IPC; and factors outside of IPC additional causes for final outcomes. Second, we present an adjusted model representing the "multi-stage multi-causality" of patient, healthcare provider, and system outcomes. Third, we demonstrate the model's explanatory power by employing it to deduce why misuse of the modified Kirkpatrick classification as a causal model in IPE and IPC outcome evaluations might have led to inconclusive results in the past. We conclude by applying the derived theoretical clarification to formulate recommendations for enhancing future evaluations of IPE, IPO, and IPC. Our main recommendations: 1) Focus should be placed on a comprehensive evaluation of factual IPC as the fundamental metric and 2) A step-by-step approach should be used that separates the outcome evaluation of IPE from that of IPC in the overarching quest for proving the benefits of IPE, IPO and IPC for patients, healthcare providers, and health systems. With this critical discussion we hope to enable more effective evaluations of IPE, IPO and IPC in the future.
尽管已经证实，跨专业教育（IPE）和跨专业合作（IPC）对提高患者护理质量、提高患者护理成本效益以及提高医疗服务提供者满意度有积极影响，但要证明这一点仍然非常困难。在这里，我们根据 IPE 和 IPC 领域中因果关系的调整理论，通过以下问题来解释这一困难：1）将 IPE 与 IPC 以及 IPE 与最终结果联系起来的因果模型主要存在哪些缺陷？2）更精确的因果模型是什么样的？3）提出的新模型能否帮助我们更好地理解 IPE 和 IPC 结果评估的挑战？在批判性理论讨论的形式下，基于对文献的批判性评价，我们首先认为，IPC 和 IPC 结果的单因果、IPE 偏向观点不能为适当的 IPE 和 IPC 结果评估提供充分的基础；相反，跨专业组织（IPO）必须被视为 IPC 的另一个必要原因；而 IPC 之外的因素则是最终结果的其他必要原因。其次，我们提出了一个调整后的模型，代表了患者、医疗服务提供者和系统结果的“多阶段多因果关系”。第三，我们通过应用该模型来解释为什么过去在 IPE 和 IPC 结果评估中错误地将改良的柯克帕特里克分类法用作因果模型可能导致结果不确定，并展示了该模型的解释力。最后，我们根据推导出来的理论澄清来制定建议，以加强未来对 IPE、IPO 和 IPC 的评估。我们的主要建议是：1）应重点全面评估作为基本指标的实际 IPC；2）应采用逐步的方法，将 IPE 的结果评估与 IPC 的结果评估分开，以全面证明 IPE、IPO 和 IPC 对患者、医疗服务提供者和卫生系统的益处。通过这次批判性讨论，我们希望能够为未来的 IPE、IPO 和 IPC 评估提供更有效的方法。
