Sesión 6 “¡Mi propia etopeya!”
VIII. ANEXOS
8.1 Transcripciones de las evaluaciones
8.1.3 Evaluación final
Introduction
This section presents the findings for the specialty clinics, which included profession-specific clinics for physical therapy, psychology, and podiatry, and clinics offering opportunities for students from multiple professions in ophthalmology, diabetes education, and women’s health. Five CMO theories were developed for the specialty clinics (see Table 20)
addressing observation and shadowing, on-site consultation, the profession-specific clinics, and the clinics open to students from multiple professions.
The specialty clinics functioned on a referral basis with referrals coming from the IP primary care teams, another pro bono clinics in the area, and the county hospital system. Speaking about the specialty clinics, a faculty clinician from the primary care team area stated:
“They have their separate area that they see patients in. We have sent patients from the clinic to them to follow up on, like another day, if it’s a physical therapy issue. Psychology, we do refer patients over to psychology, also ophthalmology. So we refer patients over to those areas” (Faculty Clinician).
The clinics were all located on the same floor of the building, with the exception of the physical therapy clinic, which operated out of the basement. The EOB minutes described how profession specific clinics were introduced on a uni-professional basis and once established attempts were then made to introduce IP opportunities. At the time of this study, the diabetes and women's health clinics were not operating due to a shortage of faculty clinicians.
Students who worked in the specialty clinics stated this environment provided little or no opportunity for them to engage in interprofessional collaboration. The available IP opportunities included observation or shadowing, and on-site consultation to the primary care teams.
Table 20: Specialty clinic CMO theories
CMO
Resource
+
Context
à
Reasoning
=
Outcome
1 Observation or shadowing in a profession specific specialty clinic • Students who observe • Observation of the assessment and treatment of multiple patients Knowing what they do, and how they do it Challenged stereotypes An expanded view of care beyond the observers own profession
Resource
+
Context
à
Reasoning
=
Outcome
2 Observation and shadowing in a profession specific specialty clinic • Students being observed • Senior students leading the observation experience and taking responsibility for representing their profession See that my profession as knowledgeable, skilled, impactful, and professional Respect my profession Elevates the status of the observed profession to an equal footing with the other in the IP SRC
Resource
+
Context
à
Reasoning
=
Outcome
3 On-site specialty consultations to the IP primary care teams • Consultations provided by senior students or faculty clinicians • Confidence representing the profession More of an expert Increased respect for my profession
Resource
+
Context
à
Reasoning
=
Outcome
4 Volunteering in a specialty clinic within an IP SRC • A lack of IP opportunities • Unsuccessful efforts to engage in IP efforts Outsiders with a different set of unique skills Increasingly uni- professionally focussed
Resource
+
Context
à
Reasoning
=
Outcome
5 The opportunity to apply to participate in an IP specialty clinic • Limited volunteer opportunities and high demand • A selection process based upon the judgement of the value of the experience to the different professions Perceived inequity Cessation of attempts to participate in interprofessional activities within the SRC
5.3.1. Specialty clinic CMO theory 1: Which seeks to explain how
observing or shadowing in a profession-specific specialty clinic
challenges stereotypes and expands the observers view of care
beyond their own profession
Box 12: Specialty clinic CMO theory 1
Resource + Context => Reasoning = Outcome
Observation or shadowing in a profession specific specialty clinic Observation of the assessment and treatment of multiple patients Increased knowledge of the observed profession by seeing what they do, and how they do it.
Challenges
preconception - it's not what I thought, it's more than I thought, I can see their perspective
Challenged stereotypes
An expanded view of care beyond the observers own profession
This experience involved students from the primary care teams observing students in the physical therapy clinic or shadowing a student in the psychology clinic (mechanism resource). It represents an additional IP opportunity for students from the primary care teams, and an opportunity for specialty clinic students to showcase their profession. Two outcomes challenged stereotypes and developing an expanded view of patient care beyond their own profession, were reported for students who observed or shadowed. The
opportunity to observe the assessment and treatment of multiple patients who presented with a variety of conditions and problems was identified as an important context in achieving these outcomes.
Context – Observation of the assessment and treatment of multiple patients
This was thought to provide the opportunity to observe the application of a wider range of knowledge and skills providing a broader view of how the observed profession works.
“ They need to see us with more patients, to see the variety involved in our work. To see the breadth involved in our work with people” (Student Leader from
Psychology).
" I think it only works when they get to see our work with different patients. They see how we work on different issues and problem, beyond what they expected to see"
(Student Volunteer from Physical Therapy).
Mechanism reasoning - Knowing what they do, and how they do it
Interviewees believed students who observed the treatment of a variety of patients see what the profession does; including how they conduct assessments, the assessment tools they use, their clinical reasoning process, the types of skills they apply and the various
observation or shadowing reported this exposure as increasing their knowledge of the observed profession, of what they do, but also of how they approach their work, how they interact with patients. They reported gaining an understanding of the unique perspective of the observed profession (mechanism reasoning).
Medical students who observed in physical therapy stated:
“Its so easy to write a referral and say, oh just go to physical therapy. But seeing those interactions, you know what’s going on at those sessions, you see how a physical therapist approaches the problem and how they interact with patients”
(Medical Student Volunteer).
“Seeing a physical therapist interact with patients, which is so different than for us in medicine. They really take time with the patients. They are very thorough, and they have a whole range of tests to help with differential diagnosis” (Medical
Student Volunteer).
A medical student who observed in psychology stated:
“ You get to see, not only what they actually do, but how they do it. They have different ways of working with patients. Like in an assessment, they ask different questions, do different tests, but it’s also how they ask them” (Medical Student
Leader).
And from a PA student who observed in physical therapy:
“They are coming from a different place, a different perspective, and you only get to see that when you see them working with patients. It was so eye-opening to me”
(PA Student Volunteer).
The students who had been observed believed many of the students from other professions knew little about their profession and held stereotypical preconceived notions about what their profession did and what was involved in their patient care. They believed
demonstrating the knowledge and skills of their profession increased the observer’s knowledge of their profession and challenged their preconceptions and stereotypes (outcome).
An observer stated the following about physical therapy:
“I had such stereotypes about what they did. Boy was I wrong. It’s so much bigger and better than I had thought. I had such a limited view of what they can do. I feel bad about it when I look back on it now. But now I can see how much they can do for patients” (Student Leader).
The following extract presents an interaction between the researcher and a student leader from medicine that observed a patient’s course of treatment in psychology.
Student Observer: “Oh my, it was so different than I expected. I guess all I knew about psychology was from TV. I expected the patient to lie down on a couch and spill the beans about how they were feeling, and the psychologist would sit with a notebook, looking serious, and taking notes. I was so wrong.”
Researcher: “ So what did you see?”
Student observer: “ All the work they put in to build, I guess you would call it rapport, a connection, so the person could trust them. How that opened the door for them to start to guide, yes guide them from there” (Student Leader).
And from a physical therapy student who was observed:
“They get to see that we are more than the stereotype, more than a gym where we just make people do exercises” (Physical Therapy Student Volunteer).
Those who had the opportunity to observe in a specialty clinic also described how the experience expanded their view of what is involved in patient care (outcome). A student leader from medicine who had the opportunity to observe and shadow in the specialty clinics describe the impact as follows:
"It was such a great learning opportunity. I was so focussed on medical school I'm only supposed to be in this realm, this little box. But you get to see the other side, a different side of healthcare. See that there's care beyond the doctor's office that has to take place, in physical therapy, or psychology. There's much more than me and what I do" (Student Leader).
5.3.2. Specialty clinic CMO theory 2: Which seeks to explain how
being observed or shadowed in a profession specific specialty
clinic elevates the status of the profession being observed
Box 13: Specialty clinic CMO theory 2
Resource + Context => Reasoning = Outcome
Being observation or shadowed in a profession specific specialty clinic
Senior students leading the observation
experience who take responsibility for representing their profession
Students from other professions see that my profession is
knowledgeable, skilled, impactful, and professional and they come to respect me and my profession
Elevates the status of the observed profession to an equal footing with other professions
The students and faculty clinicians who worked in the profession-specific specialty clinics (physical therapy and psychology) reported how being observed or shadowed by students from other professions (mechanism resource) had elevated the status of their profession (outcomes).
Context – Senior students leading the observation experience who take responsibility for representing their profession
From the perspective of the faculty clinicians and students’, observation or shadowing required senior student participation as it involved taking responsibility for representing the profession as illustrated in the following transcript excerpts.
" It needs senior students to take the lead in these observations. They know more as they have been out on their clinicals and can show the profession in a really good light. As seniors with more experience, they can show a lot more of what the profession can do" (Faculty Clinician).
" As a senior student, I can take on the role as a teacher, teach them what we do, about our approach to care, what we do for the patients" (Senior Physical Therapy
Mechanism reasoning – Seeing my profession as knowledgeable, skilled, impactful, and professional
Faculty clinicians and students viewed observation and shadowing as important opportunities to showcase their professional knowledge and skills and to present their profession as knowledgeable, skilled, impactful and professional (mechanism reasoning). The following quotation from a physical therapy student who had been observed by medical students illustrates these issues.
“ I think they come to see us as capable, professional. That what we do really does make a big difference to our patients” (Physical Therapy Student leader).
And from a student leader in psychology:
“ It’s a great opportunity for them to see what we actually do, that we are intelligent professionals. That our profession is just as good as theirs” (Psychology Student
Leader).
They believed observing their work elevates the view of both themselves and their profession in the eyes of students from other professions, develops respect for their professional knowledge and skills, and viewing them as important contributors to patient care. They believed this respect helped raise their profession to an equal footing, being seen as ‘just as good as’ the other clinic professions.
5.3.3. Specialty clinic CMO theory 3: Which seeks to explain how
providing on-site specialty consultations to the IP primary care
teams resulted in increased respect for the consulting
profession
Box 14: Specialty clinic CMO theory 3
Resource + Context => Reasoning = Outcome
On-site specialty consultations to the IP primary care teams Senior students or faculty clinicians Confident representing the profession
Senior students are more experienced and more expert
Increased respect for the consulting profession
A single CMO theory addressed the experience of senior students from the specialty clinics who provided on-site consultations to the IP primary care teams (mechanism resource). The onsite consultation involved students from the specialty clinics joining the primary care team on an as need basis. These encounters were ad-hoc in response to a need identified during the primary care team assessment. A medical faculty clinician speaking about the
psychology clinic stated:
"Sometimes we do have a patient that comes in and if it's a psychiatric issue we will actually have the psychology attending or one of the senior psychology students come in when we see the patients, after the students present. So they will actually