Interprofessional Learning Issues - Book Report/Review Example

CRITICAL REVIEW 2006 CRITICAL REVIEW Russell, L., Nyhof-Young, J, Abosh, B. and Robinson, S. (2006). An exploratory analysis of an interprofessional learning environment in two hospital clinical teaching units. Journal of Interprofessional Care, Vol. 20(1), 29-39 1. a) The research study under review focuses on the issues associated with implementation of effective interprofessional (IP) learning in clinical practicums. A concise, but solid literature review provides the background to the study and links potential findings of the research to a wider theoretical framework of collaborative approach in health professions education. In the introductory part, Russell and colleagues clearly identify the main objective of their study, namely 'to reveal students' perceptions of their education about IP interactions' (p.30). This objective is formulated to test the authors' hypothesis that the conventional learning environment does not promote positive students' attitude to collaborative practices by reinforcing the traditional disciplinary stereotypes. Another objective is to use the study findings in designing more effective (specifically in terms of timing and content) interprofessional curriculum in clinical practicums. However, the most important objective is formulated later in the study: "The point of this exploratory study was to identify effective means of analysing an IP environment" (p.38). b) Methodological framework employed by the authors for their study implies a combined or multimethod approach which includes both quantitative and qualitative methods, though the qualitative component seems to dominate. Perhaps, such combination of different research methods is employed to reinforce validity and reliability of the findings: the authors attempt to take advantage of the strengths of each method using them in such a way to compensate for limitations of each other. The context and objectives of the research suggests that using the qualitative methodology is absolutely justified. Firstly, the researchers express an interest in understanding the experiences perceived by the participants of their study and emphasize the context in which the perceptions take place. Secondly, the study is supposed to involves in-depth exploration of the issue with the authors requiring from the participants as comprehensive information as possible. Thirdly, the nature of findings revealed by Russell and colleagues suggests that the researchers have sought for deep understanding and meaning. Qualitative methodology provides the tools to fulfil all these tasks. On the other hand, the authors formulate a valid hypothesis to be tested, and in such cases quantitative methods are more appropriate. Quantitative approach, which implies use of standardized questionnaires and methods of data analysis, specific position of the researcher (considered external to the research), and replicability of the results regardless of the context has been traditionally considered to be more objective than its qualitative counterpart (Wainer and Braun, 1998). However, applicability of quantitative methods in health research is limited due to the so-called 'decontextualization' phenomenon: models built using data obtained through quantitative methods do not take into account certain variables that act in the real world context (Patton, 1987). This limitation particularly applies to the study under review. Therefore, the authors' choice of combined methodology is reasonable and justified. 2. a) The data obtained via surveying and interviewing are different in nature: consequently, the nature of findings is different as well. The surveys help the authors determine the relationship between certain variables of interest. In particular, Russell and colleagues cite the following results: No considerable cross-unit or cross-discipline differences in overall survey results; Physicians and students scored higher on the physician centrality scale than other health professionals participating in the survey. Based on these results the authors conclude that nurses and other health professionals adopt a more positive view of IP collaboration than physicians, but the data is too scarce to fulfil the research objective. Scarcity of quantitative data supports the assumption that the qualitative component dominates in the multimethod approach adopted by the authors, while the quantitative method is only an option to reinforce validity and reliability via the strategy of triangulation discussed further. The data generated via interviewing is incomparably richer. The authors prefer semistructured interview is the instrument of data collection. Semistructured interview is one of the most popular types of interviewing due to several reasons. Firstly, semistructured interviewing allow for focused two-way communication. Secondly, while the questionnaire framework implies formulation of detailed questions, a semistructured interview starts with more general topic or questions, identified ahead of time, and makes it possible for the interviewer to seek for relationships between the questions/topic and variety of relevant issues. The answers given by the interviewee serve as the basis for more specific questions formulated during the interview. And finally, semistructured interviewing is not as time-consuming and costly as other qualitative methods, while the data is valid, diverse and reliable enough to ensure in-depth exploration of the issue being studied (Glesne and Peshkin, 1992). Consequently, Russell and colleagues identify five major issues: perception of a team, communication tools, decision-making, leadership, and education. b) Interviewing is a qualitative method of data collection that has certain advantages and disadvantages as compared with other qualitative methods such as participant observation or focus groups (Mays and Pope, 2000). The advantages of interviews include ability of the researcher to involve participants whose viewpoints, status, experiences and/or knowledge of the issue being studies match the purposes of research best. The nature of interviews allows the researcher to retrieve as much information on the issue being studied as possible (Glesne and Peshkin, 1992). Therefore, the interview data add greatly to the understanding of the issues identified by the survey. While survey, as a descriptive technique, only identifies certain issues and/or relates them to each other, the interview helps the researchers understand their meaning within a context-specific setting. In fact, the survey provides Russell and colleagues with no understanding of the topic: it only describes/identifies some issues within the field of research. 3. a) The conclusions represent a brief synthesis of quantitative and qualitative findings. The authors draw the following four points: The staff of different units tend to adopt varying attitudes toward the issues of team care and collaboration, There is a common lack of explicit formal or informal IP education for the students, Students adopt positive attitudes toward teamwork and collaboration, Timing and detailed knowledge of the institutional and disciplinary context in which it will occur are the most important factors to be considered in planning an IP curriculum These general conclusions naturally originate the research data and minor findings listed throughout the paper. Only the fourth conclusion is open to certain doubt: the issue of timing is not specified as one of the primary issues within the research area, and there are barely two paragraphs dedicated to it in the paper. This may not be enough to convince the reader in critical importance of this issue. b) Since the study takes advantage of two types of research methods, the data analysis techniques are also different. Analysis of the survey data involves factor analysis carried out with the help of SPSS software. There is hardly any other way to analyse the survey data in a better way. The nature of quantitative methods, which originate from the natural sciences, requires from the researcher rather accuracy in calculations than imagination. By contrast, analysis of qualitative data requires the ability to manoeuvre across the wide range of options in order to find such combination of techniques that would ensure as accurate analysis as possible in each particular case. The process of data analysis follows the inductive paradigm, which is typical for qualitative research. Russell and colleague claim to employ the well-known method of grounded theory which focuses on the task of developing and verifying a theory grounded in systematically collected and analysed data. Each interview is tapped, transcribed and carefully read; the authors claim to employ a special coding scheme designed and adjusted keeping in mind the study's objectives. Then, using the scheme, NVivo software and services of an independent assistant the transcribed interviews have been coded. The process of qualitative data analysis is described in great detail, and there are hardly any options to make it more accurate and reliable. Perhaps, no other method of data analysis would fit the research objectives better than the one proposed by Russell and colleagues. 4. a) The authors seem to be fully aware of the major biases and limitations of their study: they explicitly acknowledge this fact by listing them. Firstly, the study involves volunteers, which increases the risk of selection bias: the study can hardly be addressed as a representative piece of research in this case. Also, Russell and colleagues admit unequal participation in the two groups involved in the research, which also damages representativeness and generalisability of the study. The survey response rates section provides accurate and comprehensive information on how many students and professionals refused to participate in each unit and what reason (lack of time) they cited for their refusal. Secondly, the overall size of the sample is too small to make any deep far-reaching conclusions/generalisations: the study involved only 43 health professionals and 19 students. Serious underrepresentation of student population is obvious. Discussing the biases and limitations the authors refer almost exclusively to the quantitative component of their research. However, they clearly admit the supplementary role of quantitative survey claiming that 'the surveys can only provide a very 'broad brush' picture. We feel that the student interviews provided a rich and detailed analysis of that environment" (p.37-38). Thus admitting that the qualitative part of research is the primary sources of data, Russell and colleagues fail list a single potential bias or limitation with reference to this part, although the qualitative methods (and interviewing in particular) are considered to have more potential biases and limitations than the quantitative methods. Data obtained during interviewing is believed to be subjective and descriptive (Murphy et al, 1998). One of the main drawbacks of this method is related to the language-imposed constraints: the researcher's questions asked verbally during the interview are believed to frame responses of the participant being interviewed (Hancock, 1998). b) The researchers' failure to explicitly list these potential biases of interviewing does not mean that they are unaware of them. On the contrary, the measures that they take to reinforce credibility and trustworthiness of demonstrate Russell and colleagues perfectly understand the limitations of qualitative methods. Two types of triangulation - a popular strategy to enhance trustworthiness of research - are employed to reduce the chance of any bias: Researcher triangulation - the research involves several to analyse the data, develop and check the coding scheme; Methods triangulation - two different strategies of data collection are employed, namely interviewing and survey; Sources triangulation - the thematic findings are "triangulated with the student surveys and with an IP literature review"(p.31). These measures are solid enough to believe that the potential biases imposed by the method of interviewing are properly and effectively addressed. At the same time, no measures are taken to remove the identified biases and limitations of the survey, but the researchers note these biases do not have any observable negative effects: generalisability and representativeness do not belong among the primary goals of the study. Emphasizing 'high contextualisation' of the environment being studied, Russell and colleagues argue that the concept of generalisability is not applicable at all. 5. a) The authors do not offer a separate description of specific strategies meant to attain authenticity in interviewing. However, solid research background of each author participating in the study suggests that authenticity has been ensured properly. Thus, the study involved different interviewers with relevant background on each stage of the interviewing process, and the chances are their qualification was sufficient to make sure the interview settings do not influence the results. The transcripts were not offered back to the participants for verification, but considering the choice of method (semi-structured interview) and the participants' prior involvement in the survey the need for such measure is minor at best. b) Despite certain limitations associated with both quantitative and qualitative methodologies, the study under review represents a solid piece of research conducted by the top-level professionals. Qualitative researchers adopt a different view on adequacy and applicability of the concepts of validity and reliability than quantitative researchers do (Kuhn, 1970). Thus, the replicability criterion is not applicable to qualitative research (Glesne and Peshkin, 1992), while the criteria of credibility, transferability and precision are treated as very important in assessment of qualitative research findings (Murphy et al, 1998). Therefore, researchers tend to develop their own concepts of validity or adopt other assessment criteria that are more appropriate in each particular case (Glesne and Peshkin, 1992). This is exactly what Russell and colleagues do. On the one hand, by emphasizing the point that the study is mainly to identify effective means of analysing an IP environment the authors dismiss majority of the conventional validity- and reliability-related criticism. On the other hand, the choice of methods, strategies, and data analysis and collection techniques perfectly fits the objectives the researchers aim to achieve. In such way Russell and colleagues ensure the soundness and trustworthiness of the research process and validity of results. REFERENCES Glesne, C., and Peshkin, P. (1992). Becoming qualitative researches: An introduction. New York, NY: Longman Hancock, B. (2002). An Introduction to Qualitative Research. Trent Focus Group Kuhn, T.S. (1970). The structure of scientific revolutions (2nd ed.) Chicago: University of Chicago Press Mays N, and C. Pope (2000) "Qualitative research in health care: assessing quality in qualitative research", British Medical Journal, 320, 50-52 Murphy, E., R. Dingwall, D. Greatbatch, S. Parker, and P. Watson (1998). "Qualitative research methods in health technology assessment: a review of the literature", Health Technology Assessment, Vol. 2(16), 141-165 Patton, M. (1987). How to use qualitative methods in evaluation. London: Sage Publications Russell, L., Nyhof-Young, J, Abosh, B. and Robinson, S. (2006). An exploratory analysis of an interprofessional learning environment in two hospital clinical teaching units. Journal of Interprofessional Care, Vol. 20(1), 29-39 Wainer, H., and Braun, H. I. (1998). Test validity. Hilldale, NJ: Lawrence Earlbaum Associates Read More