BackgroundHealthcare students must learn to collaborate across professional boundaries so they can make use of each other’s knowledge and competencies in a way that benefits the patient. One aspect of interprofessional collaboration implies negotiating what needs to be done and by whom. Research, focused on the conditions under which students perform this negotiation when they are working together during interprofessional clinical placement, needs to be further developed. The study therefore aimed to explore students’ negotiation of tasks and competencies when students are working together as an interprofessional team during clinical placement.

MethodsThe study was designed as a focused ethnographic observational study. Two Nordic sites where final-year healthcare students perform clinical interprofessional education were included. Data consists of fieldnotes, together with informal conversations, group, and focus group interviews. In total, 160 h of participating observations and 3 h of interviews are included in the study. The analysis was informed by the theory on communities of practice.

ResultsStudents relate to intersecting communities of practice when they negotiate what they should do to help a patient and who should do it. When the different communities of practice align, they support students in coming to an agreement. However, these communities of practice sometimes pulled the students in different directions, and negotiations were sometimes interrupted or stranded. On those occasions, observations show how the interprofessional learning practice conflicted with either clinical practice or one of the student’s profession-specific practices. Conditions that had an impact on whether or not communities of practice aligned when students negotiated these situations proved to be ‘having time to negotiate or not’, as well as ‘feeling safe or not’.

ConclusionsFinal-year healthcare students can negotiate who in the team has the competence suited for a specific task. However, they must adapt their negotiations to different communities of practice being enacted at the same time. Educators need to be attentive to this and make an effort to ensure that students benefit from these intersecting communities of practice, both when they align and when they are in conflict. 

Collaboration across professional boundaries is an essential aspect of health care, and interprofessional education (IPE) is a common way to help increase students collaborative abilities. Research on how and when IPE should be arranged in a curriculum remains, however, inconclusive. How students actually develop interprofessional competencies have been difficult to demonstrate and is still an under-researched area. Studying IPE in context is therefore important to understand its full complexity. This paper examines how students work with scenarios from professional health care contexts when learning together in interprofessional problem-based learning tutorials during the first year of undergraduate education. The data are video-recorded tutorials of students from medicine, nursing, occupational therapy, speech and language pathology, and physiotherapy programmes. The analysis focuses on students discussing their readings of the literature. Drawing on "Communities of Practice," findings show that students discuss and connect professional knowledge, with "brokers" (the tutors) and "boundary objects" (scenarios) supporting the emergence of students professional knowledge. The scenarios, as boundary objects, also enabled the students to turn into brokers themselves. The paper contributes to research on interprofessional learning and offers support for implementing IPE in the early stages of undergraduate education.

Scientific advances, along with better conditions for attaining healthy lifestyles, have had the result that more people live longer. On the flipside of this success, people are also living longer with diseases and are thus in need of more health care than before. This takes up available resources and the health care system must adapt accordingly. One solution that has been put forward for this dilemma is interprofessional collaboration. Resources can be used more efficiently by collaborating across professional boundaries, and we can benefit from each other's competencies in a way that serves both the patient and the system better. However, being able to collaborate with colleagues of different professional backgrounds is not a given. Just because you have a healthcare education does not mean that you automatically know how to collaborate with others. Interprofessional education must therefore be offered to health care students so they can learn to collaborate at an early stage.  

In recent years, more research has been devoted to examining the nature of interprofessional education and what students do when they work together during different interprofessional education activities. However, since interprofessional education comes in many shapes and forms, research must continue with the endeavor to understand what students do during interprofessional learning activities. It is important to expand our collective understanding of the relation between how interprofessional education is arranged and the students’ learning. The thesis therefore focuses on the relation between how students enact interprofessional collaboration during different IPE-activities and the way the learning activities are arranged. I have paid attention to what the students do, what kind of knowledge they share with each other and how, how they negotiate tasks with each other and how they organize their interprofessional collaboration. In addition, the thesis is framed by a practice-oriented approach.  

The thesis is based on four papers, all of which have been conducted with a qualitative approach. Data consist of video-recordings and ethnographic observations. Three settings are included and serve as the foundation for the thesis. In total, data collection has been conducted seven times across the three settings and been combined differently in the papers. The analysis has been supported by different theoretical concepts linked to practice theory.  

Taken together, the papers show that health care students navigate in a landscape of practices. This landscape includes both profession-specific practices and practices shared among students from other study programs. As students learn, they travel through this landscape with their sights set on the goal of working in health care. To get there, they must relate to several different areas of knowledge, ways of doing things, traditions, parallel ongoing practices and much more. They need to navigate their way forward, and they get help from ongoing guidance and support. For example, supervisors help the students understand the practices, the rooms they are in, the scene for how to act, the tasks and the scenarios which show students what is in focus. Not least, students have each other. Through themselves they can connect and share knowledge in a way that enables them to also organize and enact interprofessional collaboration. However, at times they also encounter obstacles - resulting in them ending up caught in the middle of things, not sure what practice to find safety in. Collectively, this demonstrates the importance of consciously designing interprofessional education so that students benefit from all practices in the landscape. 

Background

Healthcare students must learn how to collaborate with colleagues from different professional backgrounds and organisational units. Research has showed what students themselves think they gain from interprofessional education. Less is known about what knowledge students share when doing interprofessional education.

Purpose

This paper aims to study students’ knowledge sharing when working together as an interprofessional team at an interprofessional training ward.

Method

The study was conducted using a focused ethnographic approach. Field observations were carried out at two different interprofessional training wards. Fieldnotes, drawings and informal interviews constitute data. Data was analysed iteratively with ‘practice architectures’ as theoretical lens.

Discussion/conclusion

We found that students share knowledge in different ways during ward rounds, at the student team room and during the reflection session. The ward rounds are more formal and structured; at the student team room, things are buzzing; and the reflection session is weary.

As health care increases its focus on collaborative practice, universities must provide students with opportunities to learn how to collaborate with different professions and translate this knowledge into practice, known as interprofessional education. Simultaneously, researchers struggle to understand the full complexity of interprofessional education and must therefore conduct multiple-site studies, employ observational work, and apply theory throughout the research process.This paper draws on focused ethnographic fieldwork at two different sites focusing on how students organize collaboration during interprofessional clinical placements. Findings indicate that the way students organize their collaboration is intertwined with how patients were introduced during handovers and involved mobilizing knowledge as “betwixt and between” familiar student practices and unfamiliar clinical practices. Findings also show how authentic situations, artifacts and spatial features supported students to mobilize collaboration.

Inom PBL arbetar man ofta i grupp med andra studenter och de flesta är nog överens om att det kan vara knepigt att få till en bra rollfördelning mellan studenterna. Här kommer tre korta tips för att tänka på för att ta vara på de olika roller som behövs i en grupp.

Within PBL, you often work in groups with other students and most people probably agree that it can be a bit tricky to get a good distribution of roles between the students. Here are three short tips to keep in mind when trying to make use of the different roles needed in a group.

Inom PBL arbetar man ofta i grupp med andra studenter och de flesta är nog överens om att det kan vara knepigt att få till bra förutsättningar för det gemensamma arbetet. Därför är basgruppskontraktet är ett viktigt verktyg för ett väl fungerande basgruppsarbete. Här kommer fem tips för att skriva och använda ett riktigt bra kontrakt.

Within PBL, you often work in groups with other students and most people probably agree that it can be a bit tricky to secure good conditions for the joint work. Therefore, the contract used in tutorials is an important tool for a well-functioning tutorial group work. Here are five tips for writing and using a really good contract.

Inom PBL arbetar man ofta i grupp med andra studenter och de flesta är nog överens om att det kan vara knepigt att få till ett bra samarbete i olika grupper. Här kommer fem korta tips som hjälper er att få till en riktigt bra och effektiv grupprocess. 

Within PBL, you often work in groups with other students and most people probably agree that it can be a bit tricky to establish a good and constructive collaboration in different groups. Here are five short tips to help you manage a good and efficient group process. 

Hur är det att plugga på universitet med läs- och skrivsvårigheter (dyslexi)? Hör sjuksköterskestudenten Emeli berätta om hur hon hanterar sina svårigheter och utmaningar. Hon berättar bland annat hur det funkar med PBL, VFU och ger tips till andra studenter, både med och utan läs- och skrivsvårigheter. 

What is it like studying at the university with reading and writing difficulties (dyslexia)? Listen to Emeli, a nursing student at LiU, when she talks about how she handles her difficulties and challenges. She reflects, among other things, on how it works with PBL, during clinical placements and more. She also provides tips to other students, both with and without reading and writing difficulties.

Möten i digitala kanaler ställer lite andra krav än fysiska möten. För att få till bra diskussioner, interaktion och känsla av gemenskap är det bra att komma överens om en gemensam ”digital etikett”. Här följer åtta tips som av erfarenhet brukar bidra till bra digitala möten.

Conducting meetings in digital forums places different demands on us than if the meetings would take place in a physical room. Above all, one must think about how to create good conditions for constructive and respectful discussions. Here are eight tips that, based on experience, are known to contribute to a good digital meeting.