It’s a New Year!

Lots to learn about running a better sports medicine fellowship from Dr. Irfan Asif

What’s that you say?  A ‘new year’?  But we’re months away from January 1! It’s hardly time to sing Auld Lang Syne….

However, if you are a physician in North America, a new year most definitely has begun — whether it is July 1 for most, or August 1 for the remainder, pretty much all post-graduate medical education programs begin at this time of year.  And so, if you are involved in a sports medicine fellowship in Canada or the USA, it’s time to make some New Year’s resolutions……..

Such as.  How can I make my sports medicine fellowship better?  How might I structure a regular educational feature such as journal club in such a way as to improve the educational outcomes of the people under my charge? Read more of this post

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Working in teams – what about learning in teams? Interprofessional Education in Sports Medicine

There are a wide variety of healthcare professionals working in the sports medicine environment, whether that be in primary or secondary care, or within a sports team.

These might typically include physiotherapists, physicians, massage therapists, strength and conditioning coaches, nutritionalists, biomechanicists, sports psychologists and others.

Most of us working as healthcare professionals in a sports medicine environment are no strangers to the multidisciplinary team way of working, but how often do we think about how we learn together, and from each other, in teams?

The term ‘Interprofessional Education (IPE),’ as suggested by the Centre for the Advancement of Interprofessional Education (CAIPE), may be used to define a process that ‘occurs when two or more professions learn with, from and about each other to improve collaboration and quality of care.’ CAIPE go on to state that ‘IPE includes all such learning in academic and work-based settings before and after qualification, adopting an inclusive view of ‘professional.’

The unique concept of IPE is one of deliberately bringing together a group of heterogeneous healthcare practitioners to discuss educational topics. As a consequence of this, it is hoped that the diversity amongst the group together with effective knowledge sharing will allow for better learning for all within the group. Hopefully, this goes on to lead to improved patient care and patient outcomes.

IPE approaches to learning have been studied extensively, and Freeth (5) noted that some have indeed led to improved outcomes for patients, including improved preventative care, screening effectiveness and immunisation rates (1), improved teamwork and less perceived errors occurring in an emergency department (2), and increased interprofessional participation in planning and reviewing care (3, 4). However, there is a paucity of research on the implementation of IPE in a sports medicine environment, let alone on whether it leads to the outcomes we all desire for our patients and for our teams.

Whilst IPE can be delivered in formal settings, it is perhaps the informal settings where its practicability can be demonstrated., for example, during MDT assessments of athletes with injuries where complex contributing factors need to be assessed as part of the overall picture. Most of us involved in sports medicine will be familiar with MDT assessment in this way, and if an effective learning environment is created, then this represents a wonderful opportunity for each of the participants to learn from each other. I wonder how often we consciously think of MDT assessments as a real opportunity for learning, and treat them as such?

There are a number of possible barriers to the implementation of effective IPE. These include tensions between different professional groups such as negative stereotypes, status or salary differences, and demotivating and derogatory feedback between groups within the learning environment.

To some extent, these barriers can be avoided if one adopts appropriate ground rules. As mentioned by Freeth (5), these might be extrapolated from the ‘Contact hypothesis’ which suggests that one can reduce hostility amongst different groups by creating a learning environment where everyone has equal status, interaction is co-operative, participants are working towards a common goal, the ‘authorities’ support the initiative (eg Club management and Professional bodies), participants are made aware in advance of each others’ differences and similarities, participants share positive expectations, and participants from different groups perceive each other as typical of their group (6).

The extent to which these precedents are achievable is open for debate, and one might question whether with the wide range of healthcare practitioners involved in Sport and Exercise Medicine this might ever be achieved, or might even be desirable.

It is not uncommon to experience formal and informal IPE in the sports medicine environment, whether that may be at conferences, as part of social learning platforms such as blogs and twitter feeds, or within the workplace. In addition, formal postgraduate degree courses such as the MSc in Sport and Exercise Medicine at William Harvey Research Institute, Queen Mary University, London which I lead often have a student base made up of a wide complement of healthcare practitioners who participate and learn from each other. This is regarded as a real strength of the course.

CJSM would like to hear your views on IPE in the world of Sports Medicine– does it work for you, your colleagues, and perhaps more importantly for your patients?

 

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1) Shafer M-A et al. 2002. Effect of a clinical practice improvement intervention on chlamydial screening among adolescent girls. JAMA 288:2846-52

2) Morey J et al. 2002. Error reduction and performance improvement in the emergency department through formal teamwork training:evaluation results of the MedTeams project. Health Services Research 37:1553-81

3) Berman S et al. 2000. Assessment training and team functioning for treating children with disabilities. Arch.Phys.Med.Rehab.81:628-33

4) Walsh P et al. 1995. An impact evaluation of a VA geriatric team development program. Gerontology and Geriatrics Education 15(3):19-35

5) Freeth D. 2010. Interprofessional education. In Swanwick T (Ed.) 2010. Understanding Medical Education : Evidence, theory and practice. ASME, Wiley-Blackwell, London

6) Hewstone M and Brown R. 1986. Contact is not enough: an intergroup perspective on the ‘contact hypothesis.’ In: Hewstone M and Brown R (Eds) Contact and Conflict in intergroup encounters. pp.1-44. Blackwell, Oxford

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