Workplace learning through collaboration in primary healthcare: A BEME realist review of what works, for whom and in what circumstances: BEME Guide No. 46

Abstract

Background: Changes in healthcare practice toward more proactive clinical, organizational and interprofessional working require primary healthcare professionals to learn continuously from each other through collaboration. This systematic review uses realist methodology to consolidate knowledge on the characteristics of workplace learning (WPL) through collaboration by primary healthcare professionals.

Methods: Following several scoping searches, five electronic bibliographic databases were searched from January 1990 to December 2015 for relevant gray and published literature written in English, French, German and Dutch. Reviewers worked in pairs to identify relevant articles. A set of statements, based on the findings of our scoping searches, was used as a coding tree to analyze the papers. Interpretation of the results was done in alternating pairs, discussed within the author group and triangulated with stakeholders’ views.

Results: Out of 6930 references, we included 42 publications that elucidated who, when, how and what primary healthcare professionals learn through collaboration. Papers were both qualitative and quantitative in design, and focused largely on WPL of collaborating general practitioners and nurses. No striking differences between different professionals within primary healthcare were noted. Professionals were often unaware of the learning that occurs through collaboration. WPL happened predominantly through informal discussions about patient cases and modeling for other professionals. Any professionals could both learn and facilitate others’ learning. Outcomes were diverse, but contextualized knowledge seemed to be important.

Discussion/conclusions: Primary care professionals’ WPL is multifaceted. Existing social constructivist and social cognitivist learning theories form a framework from which to interpret these findings. Primary care policy makers and managers should ensure that professionals have access to protected time, earmarked for learning. Time is required for reflection, to learn new ways of interaction and to develop new habits within clinical practice.

Notes

Acknowledgements

The reviewers wish to acknowledge Daisy De Sutter, librarian, for her help and support with building and adapting the search syntaxes.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Glossary

Workplace learning (WPL) is “learning taking place at work, through work and for work” (Tynjälä 2013), which for medical professionals occurs during clinical practice. This review focuses on WPL occurring as a result of collaboration with healthcare professionals from the same or from different disciplines, at the same location or across organizational boundaries.

Collaboration happens when multiple health workers from different professional backgrounds work together with patients, families, caregivers and communities to deliver the highest quality of care. It allows health workers to involve any individual whose skills can help to achieve health goals (Gilbert et al. 2010). WPL may arise as a result of collaboration between professionals with the same educational background (intraprofessional), but as a consequence of the rise in interprofessional collaborative practice, increasingly arises from the interaction between professionals from several disciplines working together to care for the same patient (interprofessional) (Hammick et al. 2007; Parboosingh 2002). In this review, we focus on understanding WPL arising as a result of both interprofessional and intraprofessional collaboration.

Primary healthcare is a discipline that has not been defined uniformly in diverse healthcare systems around the world. In Europe, the term is used to refer to community-based settings rather than hospital settings. General practitioners (family physicians), pharmacists, nurse practitioners and physiotherapists are just some members of this discipline (Schellevis and Groenewegen 2015). In the United States, the term ‘primary healthcare’ is used to refer to office-based practices (either family medicine, internal medicine or pediatrics) where the focus is on primary care delivery. In this review, in order to be relevant to practice worldwide, we adopted an inclusive view on primary healthcare and included papers describing primary healthcare as defined in the country where the research was undertaken.

Notes on contributors

Fien Mertens, MD, PhD student, is a GP and communication skills trainer for medical students. Her PhD project focuses on integrated care for palliative patients, and her main research interests pertain to inter-professional collaboration, communication, palliative care and workplace learning. She is an advisory member in a research group conducting a realist review and facilitates workshops on realist reviews.

Esther de Groot, PhD, is an Assistant Professor in the learning sciences. Her main research interests pertain to workplace learning, through boundary crossing, of (bio)medical professionals. She has undertaken training in methods of research synthesis and of qualitative research.

Loes Meijer, MD, PhD student, is a GP, researcher and developer of intraprofessional education for medical specialists and GPs (trainees as well as professionals). She has undertaken training courses in methods of qualitative research and the International Primary Care Research Training Curriculum.

Johan Wens, MD, PhD, Professor in Family Medicine, is a GP. His main research interests are situated in the field of chronic care delivery and interdisciplinary health care with special interest for topics as multi-morbidity and poly-pharmacy. He is involved in different research projects related to adherence to treatment, therapeutic patient education, healthy aging, informal caregivers and palliative care.

Mary Gemma Cherry, BSc, PhD, DClin Psych, is a Lecturer in Clinical Health Psychology and Clinical Psychologist in a specialist psycho-oncology service. Her main research interests align with her clinical interests, and relate to adjustment to, and coping with, chronic diseases such as cancer. She has previously worked as a systematic reviewer and has authored a textbook for students undertaking a systematic review as part of their postgraduate studies.

Myriam Deveugele, MA, PhD, is a Professor of Communication in Healthcare, and heads a research group on medical communication. She is also responsible for communication curriculum development and communication skill teaching. She is ex-president of the EACH: International Association for Communication in Healthcare.

Roger Damoiseaux, PhD, is a Professor in General Practice. His research focuses upon education in evidence based medicine and interprofessional collaboration.

Ann Stes, PhD, promoted in 2008 to doctor in Educational Sciences with her PhD thesis entitled ‘Instructional development in Higher Education: Effects on Teachers and Students.’ Her postdoctoral research concentrates on the professional development of teachers and the impact of training.

Peter Pype, MD, PhD, is a GP and communication skills trainer for medical students. His research interests center around palliative care, communication, interprofessional collaboration, workplace learning, complexity science. He has undertaken a two-day course on Qualitative Evidence Synthesis with workshops on realist synthesis by Andrew Booth, ScHARR, University of Sheffield. He is an advisory member in a research group conducting a realist review and facilitates workshops on realist reviews.

Notes

1 Although the phases of abstract selection and analysis are presented as sequential, they happened overlapping and iterative, as is characteristic for realist reviews (Pawson et al. 2005).

2 In each figure, C-M-O configurations are illustrated using arrows, with references to the relevant included papers in the review. Where no configurations could be made, references pertain to individual C-M-O elements.

3 Throughout this review, we use the term ‘facilitator’ to refer to anyone who facilitates another’s learning. As such, the facilitator may be a teacher, as well a professional functioning as a role model.