Análisis de los principales problemas detectados en el sector del alojamiento

Even when these institutional obstacles are overcome, participants left to apply IPL in their respective workplaces, often encounter resistance (Barr et al., 2000). Barriers to IPE include differences between disciplines in history and culture, academic schedules, professional identity, accountability and clinical responsibility and, expectations of professional education (Headrick et al., 1998). Further to this, interprofessional rivalry, negative stereotyping and ignorance of the role and contribution of other professions are recognised as barriers to teamwork and hence effective healthcare (Barr, 2001). There is increasing interest in developing and evaluating the effects of pre-qualification IPE conducted in clinical settings (Davidson et al., 2008). However, the use of service-learning models or interprofessional problem-

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based learning strategies requires selection of motivated and skilled faculty members or additional training in non-traditional teaching methods (Hall & Weaver, 2001). The quality of tutoring and student support are important factors when developing interprofessional training in a clinical setting (Ponzer et al., 2004), where effective teamwork is an essential component of safe healthcare (Davidson et al., 2008). The review clearly highlights the effect attitude of individuals may have on IPE implementation within organisations, plus further reinforces the importance of appropriate planning of and for IPE.

Such planning includes building relationships between key stakeholders, including the recruiting and training of facilitators, plus preparing students and facilitators for the experience (Davidson et al., 2008). Adults learn best when there is collaboration and mutual respect between learners and facilitators, which also informs curriculum development (Knowles, 1975). However, such collaboration does not always exist; for example, tutors are sometimes found not to pay equal attention to diverse work settings (Barr et al., 2000). Specialisation of training and roles appears to entrench a stereotyping of attitude, which leads to support for early embedding of IPE and its assessment as part of all pre-registration education (Barr et al., 2000).

IPE is proposed as a way to reduce this silo mentality, as it is seen to change attitudes and perceptions by enabling participants to learn with, from and about one another in ways that counter prejudice and negative stereotypes, thus helping to overcome barriers to collaboration (McMichael & Gilloran,

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1984). It cultivates interpersonal, group and organisational relations by creating opportunities for participants to become more aware of their relationships with others (Barr et al., 2000). However, this raises the question of how IPE is successfully initiated and integrated into environments where stereotyping already abounds within those who make policy decisions.

To this end, an understanding of both professional roles and group skills is thought to aid IPE (Hall & Weaver, 2001). Practitioners, who also work in education, combine a professional practice and a university teaching role; research into such roles could inform linking of theory and practice but may also clarify ways in which such roles straddle two very different organisational and value-driven cultures (Murphy, 2000). Lecturer practitioners are aware of serving the needs of very differently perceived cultures and could inform practice based IPE through exploring the concept of combining cultures in a practical context (Fairbrother & Mathers, 2004). Clinician/educators could potentially have ideal skills to initiate and enhance practice-based IPE in an environment such as LSO.

Both teacher and learner characteristics are key factors in IPE (Reeves & Freeth, 2002). For example, senior practitioners have experience to exchange and can influence changes in practice. Such diverse participant backgrounds may enrich comparative learning about collaboration (Barr et al., 2000). Facilitator styles are important to students (Reeves, 2000; Reeves & Freeth, 2002); allied to this, supervision quality is the most important contribution to student satisfaction (Ponzer et al., 2004). Staff training

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implications exist where educators are required to act as role models, with students indicating that the success of placement shared learning is linked to the encouragement given by teachers (Morison et al., 2003). Successful IPCE requires enthusiasm and commitment of all stakeholders, commitment of institutions, transparent communication, use of a variety of training methods and adequate resources (Davidson et al., 2008). Stakeholder capability affects IPE and may be related to their own training and development. The success of IPE also depends on interactive learning (Barr et al., 2000), thus recognising the role of the learner.

Student characteristics of flexibility, co-operation, open mindedness, and a willingness to make suggestions, are recognised as important contributors to successful IPCE (LaSala et al., 1997; Russell & Hymans, 1999). Learner expectations, beliefs and motivations about IPE, collaborative care and other professions influence IPE outcomes (Hammick et al., 2007), with more mature and experienced learners found to be more favourably disposed towards IPE than younger and less experienced learners (Tunstall-Pedoe et al., 2003). Although there appears to be little overall evidence relating to the influence of previous IPE on participant attitudes to subsequent IPE (Hammick et al., 2007), there are differences between the willingness of students from different professional groups to participate in optional IPE. Repetition of previous uniprofessional study reduces participation (Cooke et al., 2003) and students are reluctant to spend time on non-assessed study (Morison et al., 2003). Timetabling issues cause a reluctance to participate, especially where students perceive IPE interventions to be less important

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than other study sessions (Reeves, 2000; Morison et al., 2003; Cooke et al., 2003). This reinforces previous findings relating to planning but also raises the importance of appropriate assessments of and student attitude to IPE.

Several factors influence student perceptions of IPE: stereotyping and negative views of respective professional roles are widely identified (Reeves, 2000; Cooke et al., 2003; Hammick et al., 2007). Tunstall-Pedoe et al. (2003:169) conclude that: ‘…any notion that students arrive without preconceived ideas about other professions is misplaced.’ Professional orientation influences IPL; age, previous work experience and profession interact to influence students’ views about other professionals and collaborative care (Pollard et al., 2005). Fear of failure in front of others concerns all students, irrespective of professional background (Dienst & Byl, 1981). Therefore, for IPE to be successful, the learner environment appears to be critical and must overcome these barriers.

To achieve this, different healthcare settings could be significant to successful IPE as they may provide more conducive environments for participants. For example, the hierarchical relations existing between professions in hospitals are inappropriate in the outside community, where teamwork is required to meet the needs of service users (Cooper et al., 2001). Diverse student groups have different perceptions of learning interventions, which in turn are reflected in their views of professional and faculty support for IPE initiatives. Many individuals involved in patient care are competent and dedicated but have ineffective working relationships

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(Hindle et al., 2006). The historical professional hierarchy within secondary care may influence teaching in this environment and, as such, reinforce stereotyping, whereas primary care environments, such as LSO, where teamwork is seen as an essential pre-requisite may be more conducive to promoting IPE and reducing such stereotypical attitudes. Certain professions are also more involved with IPE than others.

Demographics and professions involved