Health care is increasingly complex and must draw upon the distinct, yet complementary skills of various health disciplines. Integration of health professionals as students through interprofessional education (IPE) is 1 way to promote early, and subsequently sustain, the principles of teamwork.

A number of countries in the Middle East are undergoing rapid expansion in population and associated services for its residents. Over the past decade, Qatar has invested heavily in both health and educational infrastructure in commitment to develop its human capital. Domestic clinical education programs for various health care providers have been launched, including nursing and pharmacy.1 As these various curricula emerge, there is a unique opportunity to develop and incorporate interprofessional health education within this specific cultural context. We describe an IPE initiative between the nursing and pharmacy education programs in Qatar.

Description

The Canadian-accredited College of Pharmacy at Qatar University has graduated small classes (n = 25) of 5-year baccalaureate degree pharmacists since 2011. The University of Calgary-Qatar (UC-Q) nursing program has offered regular and postdiploma baccalaureate degrees to classes of approximately 400 students since 2006.

Diabetes care is taught within the fall semester in both curricula's second-year courses. Associated faculty members created a case encompassing the progress of patient care through 4 stages of diabetic ketoacidosis (DKA): (1) diagnosis and initial emergency department management, (2) critical care admission, (3) transition to a general medicine ward, and (4) discharge planning for home. Instructors collaborated to identify general and discipline-specific preparatory readings and self-study questions to enhance student preparation. As 1 mechanism to evaluate feedback about this instructional strategy, consenting students completed an IPE survey.2

Twenty pharmacy students joined 8 nursing students for a 2-hour session at the UC-Q campus. Instructor welcome and introduction were followed by a short "icebreaker" activity. Four groups were formed with predetermined mixed-discipline members and assigned 1 of the 4 DKA case stages. In the 30 minutes allotted, students collaborated to answer pathophysiology and pharmacology questions linked to the DKA care stage and to formulate and prioritize an individualized patient care plan according to assessment of the patient information provided, the requirements for medical management, and anticipated follow-up needs.

All members then convened for each group's 15-minute presentation of their respective assessment and management plan followed by open class discussion and clarifications. The session concluded with an instructor-delivered summary of the main points and closing remarks. Students repeated the IPE survey.

Only a few nursing (n = 4) and pharmacy (n = 5) students reported previous experience with a structured IPE activity. Pharmacy students expressed favorable views about IPE that were further strengthened following this session as evident by the increase in positive survey responses. However, some attitudes related to perceived need for intergroup knowledge differentiation were found. Nursing students also reported high levels of agreement with the tenets of IPE that were sustained in the postsession survey assessment. Sentiments included the confidence to portray themselves as professionals with high level of knowledge and understanding in the subject matter. The cohort was unanimous in its desire to engage in multidisciplinary sessions in the future.

Discussion

The World Health Organization strongly encourages efforts to incorporate IPE into health profession education programs recognizing that patient and population outcomes are improved through multidisciplinary and collaborative care; however, there is a dearth of experience reported from the Middle East. Four years ago, a Qatar Interprofessional Health Council was formed, and various research projects launched under its auspices, but until now, little actual activity meeting the true definition of IPE, the convergence of educators and learners from 2 or more health professions who jointly create and foster a collaborative learning environment, has taken within place within the curricula across disciplines.3,4

While joint simulated management of patient cases among nursing and pharmacy students is not a novel IPE activity,5 it is the first to be conducted among these undergraduate health profession programs in the country. Indeed, its collaborative development was informed by the experience of others, including the importance of alignment with previous learning, preparatory resources, a physical environment conducive to interaction, and balanced team structure,6 although our group makeup was 3:1 pharmacy-to-nursing students because of disparate class size. Recently, a multicampus Qatar IPE Committee has been formalized to plan the systematic delivery of future IPE activities across different professional years among these and other domestic curricula. Not only will this group work to incorporate additional expanded combinations of disciplines in IPE activities (such as nutrition, respiratory therapy, and medicine), but also guide collaboration of patient case writing and coordinate IPE professional development opportunities for facilitating faculty members. Such initiatives will further inform improved delivery of this DKA IPE activity in upcoming semesters.

Marginal change in reported positive views toward IPE was observed following this IPE activity. This could be attributed to favorable preexisting attitudes, which, in turn, could be linked to the proportion of North American-trained instructors at both these campuses. Each program is linked to Canada, where practice models of collaborative patient care and curricular models of IPE are well established. The timing of IPE initiatives may be a matter of some debate in that early immersion into IPE could impair students' ability to first form their own professional identity.7 Such concern may hold particular relevance in the Middle East region where allied health professions currently struggle with poor perceptions of roles and unfavorable public image.8,9 Further anecdotal feedback following the session included some participant uncertainty regarding tackling the case as a team as opposed to a "division of labor" approach within and across students in the 2 health disciplines. Pharmacy students in our group expressed a perceived need to be "superior in academic abilities" and might suffer from unrealistic expectations of future integrated learning.10 Such impressions indicate collaborative learning in controlled settings may be necessary to promote recognition of complementary skills and expertise, before stereotypes take root. Finally, although at present not part of the current IPE Committee mandate, there is potential to shift cultural and societal mindsets toward collaborative care in ambulatory and institutional practice in the country as students undertaking IPE learning experiences emerge from our programs into the workplace to deliver patient care.11

Conclusions

Undergraduate nursing and pharmacy students in Qatar participating in a structured course-based IPE activity to assess and manage a DKA case expressed initial high value for integrated learning and further positive feedback following the session. This initial experience, coupled with the multicampus IPE Committee directive, will inform future activities to enhance understanding of interprofessional knowledge and skills and reinforce the value and steps in collaborative patient care.

References