“Ego massaging that helps”: a framework analysis study of internal medicine trainees’ interprofessional collaboration approaches

ABSTRACT

Introduction

Patient care depends on collaborative practice. Debate remains as to the best approach to providing education for collaboration, with educational interventions often far removed from the realities of the clinical workplace. Understanding the approaches used for collaboration in clinical practice could inform practical strategies for training. For internal medicine trainees, this involves collaboration with other professions but also with other specialties. This study aimed to explore the approaches that internal medicine trainees use for interprofessional collaboration and the ways that these approaches vary when internal medicine trainees interact with different healthcare provider groups.

Methods

Following ethical approval and participant consent, interprofessional communication workshops between August 2020 and March 2021 were audio recorded and transcribed verbatim. Workshops involved groups of internal medicine trainees discussing collaboration challenges and the approaches they use in clinical practice. This framework analysis study used the interprofessional collaboration framework described by Bainbridge and Regehr (building social capital, perspective taking and negotiating priorities and resources), and cross-referenced the categorised data with the healthcare groups that trainees collaborate with, to look for patterns in the data.

Results

Seventeen workshops, involving 100 trainees, were included. Trainees described relationship building, perspective taking and negotiating priorities and resources. Relationship building was a modification to the original framework domain of building social capital. Themes of power and civility transcended domains with evidence of using hierarchy as leverage when negotiating and employing civility as a tactical approach throughout.

Discussion

This bi-dimensional analysis highlights patterns of perspective taking when collaborating with other specialties and professions, and the approaches to negotiation of courting favour and coercion when interacting with other specialties. This study provides evidence of the strategies currently utilised by internal medicine trainees, with different healthcare groups, and presents a modified framework which could inform the development of training for collaboration.

KEYWORDS:

• Interprofessional collaboration
• internal medicine
• continuing professional development
• framework analysis
• qualitative research

Acknowledgments

The authors thank all of the trainee participants, along with Jemma Pringle, Fiona Farquhar and Ben Elyan who facilitated the interprofessional workshops, Julie Mardon and Tanya Somerville for their support and provision of access to the Scottish Centre for Simulation and Clinical Human Factors for this research, and Elizabeth Johnstone for her assistance in the transcription of the data. We would also like to thank Sandrijn van Schaik for her helpful comments on an earlier draft of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Author contributions

JK led the conception and the design of the study, data collection, data analysis and interpretation of the data, and the drafting and the revision of the manuscript. SES contributed to the conception and design of the study, the analysis and interpretation of the data, and the drafting and the revision of the paper. VT contributed to the conception and design of the study, the interpretation of the data, and the drafting and the revision of the paper. All authors (JK, SES and VT) approved the final manuscript for publication and have agreed to be accountable for all aspects of the work.

Additional information

Funding

This work was supported by a small grant award from the Scottish Medical Education Research Consortium (SMERC). It was also funded as part of the Internal Medicine Training Simulation Strategy via NHS Education for Scotland.