Realist approach to evaluating an interprofessional education program for medical students in clinical practice at a community hospital

Abstract

Introduction: We examined the interrelationships between context, mechanism, and outcome using a realist approach following the introduction of interprofessional education (IPE) to clinical practice for medical students in the community.

Methods: Through participant observation and interviews, a working hypothesis was developed. To evaluate IPE in clinical practice, medical students’ reports were thematically analyzed, and configuration on contexts, mechanisms, and outcomes were identified using a realist approach.

Results: Influential contexts were medical students’ experience of clinical practice and learning characteristics, the capacity of other professionals, interprofessional relationships, and characteristics of the community hospital. One key mechanism was observational learning. Others were self-regulated learning, legitimate peripheral participation, experiential learning, contact hypotheses, awareness of social structure, and cognitive empathy. As faculties supported these key mechanisms, medical students became aware of the legitimacy of community-oriented primary care, noting the roles of physicians who support patients’ and/or their family’s life in collaboration with other professionals, and reflecting the necessity of shifting from physician-centered perspectives. As a result, medical students deepened their empathic understanding for other professionals.

Conclusion: Faculties should develop IPE programs in clinical practice based on the ‘mechanism’, ‘context’, ‘outcome’ pattern and ‘context-mechanism-outcome’ configuration in primary care settings.

Acknowledgments

We thank the healthcare staff in the community hospital for supporting the practical training of medical students.

Disclosure statement

The authors report no conflicts of interest. JH and YY contributed to the design and implementation of the program and the research, to the analysis of the results and to the writing of the manuscript.

Additional information

Funding

This work was supported by JSPS KAKENHI Grant-in-Aid for Young Scientists (B) Grant Number JP19K19377.

Notes on contributors

Junji Haruta

Junji Haruta is a family physician and researcher in primary care, medical education and interprofessional education. He was given PhD degree from Department of International Research Center for Medical Education, the University of Tokyo. In 2017, he acquired the Certificate in Measurement and Assessment in Medical Education in Iowa University. He has worked as associate professor in Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba since April 2019.

Yu Yamamoto

Yu Yamamoto is a family physician with research in interprofessional education. She has been a PhD student in Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba since April 2019.