Challenges to Interprofessional Education: will e-Learning be the Magical Stick?

Figures & data

Box 1 Case Scenario with Proposed Questions

Case scenario (for small group assignment) Time: Up to the midnight of …………. Nada, a fourth-year student who is doing her obstetrics and gynecology rotation, is spending a day in a university obstetrics clinic. After she has seen several patients and observed a couple of procedures, the attending physician, Dr. Omnia, hands Nada a chart filled with background information and a hand-out listing the information she will need to gather and instructs her, “Nada, please go learn this patient’s story and see what kinds of questions she has about the procedure.” The first thing Nada notices when she opens the chart are the words “trisomy 21”. She knows well what this means — in addition to her medical training, she has an adult brother with Down syndrome. As she continues to read, she learns that the woman, Fouzia, is 33 years old and is 11 weeks pregnant. Fouzia has had a long battle with infertility because she has mosaic Turner’s syndrome. She has had seven miscarriages but has a one-year-old son at home. At eight weeks gestation, Fouzia had an abdominal ultrasound that showed thickening of the nuchal fold. She subsequently had cell-free fetal DNA testing which indicated she had a high chance of having a child with Down syndrome. Nada wonders what kind of counseling Fouzia received prior to arriving in the obstetric clinic, particularly since she has not had a true diagnostic test for Down syndrome, such as a chorionic villus sample, and there were no notes in her health record from any genetic counseling sessions. Nada takes a deep breath and knocks on the patient’s door. Inside the room, she finds a teary-eyed woman, sitting and holding hands with her husband. When Nada asks Fouzia about her story, she explains, “We were so happy to be pregnant again after having so many miscarriages. It was devastating to learn about the Down syndrome. We just…can’t imagine putting that kind of burden on our family.” Nada responds, “I’m sorry to hear that you’ve been through so much. I hope that we can provide the support you need.” She goes on, “Do you feel as though you have received adequate information about Down syndrome?” Fouzia nods, tears streaming down her cheeks; her husband stares at the floor. Fouzia seems to regard the cell-free DNA test as diagnostic of Down syndrome; this worries Nada, particularly since it seems that she has not received any counseling. She’s also concerned that Fouzia’s and her husband’s decision to abort might not be an informed one. Nada feels some obligation to speak up on behalf of the often-underestimated and undervalued population of people with Down syndrome. She wonders whether to speak to Dr. Omnia and to Fouzia and her husband about her concerns, and she wonders what to say. In no more than 400 words ● Discuss all the potential options for deciding about this pregnancy. ● Explain the role of autonomy, consenting, unbiased information in decision making regarding this pregnancy. ● What is the proper final decision that should be taken in this case? Based on what?

Box 2 Course Objectives and Learning Outcomes.

Goals:

By the end of the course, nursing and medical students should:

1. Be familiar with basic concepts and principles of health bioethics in the context of interprofessional practice.

2. Be able to utilize moral reasoning and analytical thinking skills to make decisions about simple ethical dilemmas.

3. Appreciate collaborative and team-based approach in dealing with ethical dilemmas.

Learning Objectives:

By the end of this course nursing and medical students should be able to:

1. Differentiate between professional ethics and regulations.

2. Discuss the concept of “honor of the healthcare professional”.

3. Discuss the ethical bases and duties of healthcare practitioners in relevance to: Autonomy, Confidentiality, Consenting, Practitioner-patient relationship, and End of life care.

4. Discuss ethical backgrounds of: documentation and authentication, financial affairs in the healthcare field, conducting biomedical research, dealing with the emergent conditions in healthcare practice, dealing with emergency situations, dealing with life-threatening and incurable diseases.

5. Value interprofessional education as a means for future efficient interprofessional collaboration.

Note: Data from Cheftel.¹⁸

Table 1 Collective Score of Group Members in the Large Group Discussions

	Case 1	Case 2	Case 3	Case 4	Case 5	Case 6	Case 7	Case 8	Total
	10	10	10	10	10	10	10	10	80
Group A	2.2	2.7	3.3	1.7	3.4	2	2.7	2	20
Group B	2.5	2	3.3	0.5	2	2	3.3	2	17.6
Group C	2	0.5	2.7	1.5	2	3	2.8	3.8	18.3
Group D	3.5	3.7	5.5	6	5	4.7	4.3	5.2	40
Group E	4.3	5.7	5.3	4.8	5.5	6.3	5.3	5.3	42.5

Table 2 Small Group Assignments

	Assignment 1	Assignment 2	Assignment 3	Assignment 4	Total
	10	10	10	10	40
Group A	7.5	8	7.5	–	24
Group B	8	8.5	5	–	21.5
Group C	7	10	9	6	32
Group D	8.5	9	9	10	36.5
Group E	8.5	10	8	9.5	36

Table 3 Means and Standard Deviation of the Three Scales of ISVS Questionnaire (Scales Were Rated Out of 7)

Scales	Number of Items	Mean	Standard Deviation
Self-Perceived Ability to Work with Others	9	5.81	0.78
Value in Working with Others	9	5.52	1.2
Comfort in Working with Others	6	5.32	0.79

Table 4 Students’ Satisfaction with the Online Experience as Well as Their Gender and Affiliation Differences (Overall Satisfaction Was Rated Out of 5)

	Mean (SD)	t-Test	Significance
Overall satisfaction of students with the online course
Overall course satisfaction	4.2 (0.83)	NA	NA
Satisfaction of the two genders with the online course
Male	4.3 (1.11)	0.0	1.00
Female	4.3 (0.76)
Satisfaction of students from the two programs with the online course
Medicine	3.7 (0.95)	−2.8	0.03*
Nursing	4.9 (0.38)

Note: *Significant.

Box 3 Challenges Identified by the Students, Faculty, and Course Coordinators

1. Distinct identity between nursing and medical students

2. Lack of resources for implementation of IPE. These are mainly: ● Trained and motivated faculty members, and ● Time in already crowded medical or nursing curricula.

3. The inability to conduct relevant hands-on sessions through the online teaching.

4. The difficulty in maintaining equal opportunities of interaction for the nursing and medical students.

5. Making the IPE e-learning experience sustainable.

Cheftel J. Bioethics Core Curriculum Section 1: Syllabus Ethics Education Programme. Paris: UNESCO; 2008.

 Google Scholar