Throughout my time on the Year 1 Inter Professional Education (IPE) programme, I have compiled this portfolio consisting of a reflective account on my performance in throughout the programme. Included in this file are a number of secondary resources utilised in constructing the account as well as in aid of assembling the team presentation.
My IPE group consisted of 4 medical, 2 pharmacy and 3 nursing students. As a multidisciplinary team, we collectively produced a presentation regarding clinical communication and ethical considerations in patient centred healthcare. Our theme was based around the growing issue of underage pregnancies throughout the capital. The wider issues of this topic ranging from the ethical, psychological, and moral implications as well as the great variety of healthcare professionals involved in managing such incidences. We chose this topic as it was something the whole group had differing views on and wanted to explore further.
A copy of the article, "Policy 'disaster' as teen pregnancy rate rises to its highest in 10 years", is included for the benefit of the reader. This article from the Times Online was the key inspiration behind our choice of topic as it outlines the huge extent of the problems posed by teenage pregnancies. According to the article Britain has the highest incidence of teenage pregnancies in Western Europe. Despite the highly sensationalist tone and the incomprehensive survey of the contributing factors of teenage pregnancy, the article does offer a fascinating introspection into the ethical issues regarding pregnancy among girls below 16, the age of consent.
The 'slideshow' utilized during the team presentation, 'Yvonne at the clinic', is included for the benefit of the reader. As one can see it contains the key concepts the team touched upon during the presentation which was interspersed with a model role-play featuring a consultation at a sexual health clinic. Moreover, the script for the role-play has also been enclosed to help the reader appreciate the team's corroboration in conveying current issues integrated in a model scenario. Please find enclosed further evidence highlighting our effective teamwork comprising of emails, peer review forms and a diary of progress which had been logged between the IPE sessions.
The essential features of a team and how it develops have been explained by Tuckman's summary of team development (1965). The model was used as a reference point for the groups progress, evaluate the team's development and to contemplate the next stage of action. The reflective account further vindicates how Tuckman's summary is clearly not exhaustive in describing the great spectrum of team behaviours. Instead, the IPE programme has enlightened the view that group dynamics are variable and so mechanical. Therefore the unpredictability arising amongst different teams, especially multi and possibly more vast amongst inter-disciplinary teams reinforces the belief that there are many contributors which affect group work.
To conclude, I hope the reader finds the following account and secondary sources beneficial. In the time that has been allocated, I have tried my utmost to submit an honest account of my contribution to the IPE programme.
In this reflective account, I will evaluate and analyse my performance as a team member throughout the IPE programme using the Kolb (1984) cycle1. David Kolb argues that experience is the source of learning and development. The cycle constitutes the following four stages; Concrete Experience, Reflective Observation, Abstract Conceptualisation and Active experimentation. Kolb's cycle suggests it is necessary to reflect on an experience, evaluate it and formulate concepts, which can then be applied to new situations such as working in a multidisciplinary team (MDT) 2. CAIPE uses the phrase "interprofessional education" (IPE) as a generic term which "occurs when two or more professions learn with, from and about each other to improve collaboration and the quality of care" CAIPE (2007)3.
Our team consisted of nine people (four medical, three nursing and 2 pharmacy students). The application of an inquiry based learning (IBL) technique, would allow us to enhance our problem solving and communication skills. Over a period of five weeks, the team managed to present an ethical case study conveying the importance of communicative efficacy and ethical considerations within MDT's in providing patient centred care. In this paper I incorporate theoretical principles to the team's performance4-7 in a bid to divulge a deeper understanding of how and why I improve specific areas of my performance as a team member.
In the first IPE session, our objective was to decide the focus of our inquiry. Right from the onset, to my disbelief, the group was extremely focused and driven to the task at hand. Initially I was hesitant mainly due to the exposure of so many strangers with varying personalities but equally eager to 'think aloud'4. This threatening situation meant that any early communication was difficult and for a considerable amount of time I found myself very quiet8. The reason for this was that my views towards this task were initially sceptical because of previous prejudices held against other disciplines. However, as the meeting progressed, I learnt that such presumptions had no basis and had arisen due to a lack of contact between the disciplines.
A consensus was reached within the group to carry out our task along the lines of teenage pregnancy among girls below 16 and the wider implications it acquires. The session also included a simulated patient interview, which proved very informative and clearly highlighted the fundamental concepts of a consultation; rapport, empathy, body language, active listening and question styles. By the second session the group had conducted some research on loosely related material regarding the growing problem of teen pregnancies in the UK. In this student led session, we made a decision to commence the planning of the actual task. This was a very time consuming step to achieve as fellow members failed to comprehend the purpose of the goals we had set, since our task had a large scope and appeared vague. I felt it was my duty to urge the group to clear any misconceptions at this early stage and to channel our broad research into three specific concepts which are imperative to portray to our audience. I put particular emphasis on the current NHS guidelines, ethical issues and relevant multidisciplinary team approaches concerning the scenario5. Our concrete material - which would provide the foundational premise for the duration of the course - was provided by an article claiming "Policy 'disaster' as teen pregnancy rate rises to its highest in 10 years"9. This article presents great scope for discussion including the ethical issues and the role of MDT's in managing such a growing problem.
According to Bruce Tuckman (1965) there are a number of key issues relating to effective team discussion and behaviour10. Stage 1 is the 'forming' phase and it depicts a team's natural instinct for guidance. Therefore, the premise for advancement for a particular group resides in the election of a leader. When discussing and deciding the topic for our presentation it became clear that certain individuals were more confident than others and my substantial contributions during the second session5, led me to assume leadership. Although my position involved delegating specific tasks to individuals, the group as a whole was very diplomatic and hence there was no need for an autocratic leader. As a result of this, the storming phase, which Tuckman described as the episode where decisions are most challenging, was a much rapid and unproblematic phase. This was because we all had a genuine interest in the topic and felt we each could contribute to the issue.
The allocation of roles was carried out based on prior research. For instance, the individual whom had researched the healthcare team had the task of producing their own slide for the PowerPoint presentation. In addition the norming process of Tuckman's model was also coming into the fore as our 'keen actors'6 were making great progress in their role-play of a consultation at a sexual health clinic. My contribution to the presentation consisted of a brief explanation of the importance of consent and whether a minor can consent to their own treatment (i.e. Gillick case, Fraser guidelines) 11, 12. Overall, continual discussion and communication between members mainly via emails enabled the presentation to evolve into the polished product which portrayed the efficient performing (final) phase of Tuckman's model.
The team worked in an efficient manner after a sluggish start. The initial reservations were quickly diminished which helped us to progress towards our goals. During the days leading to the final presentation, I and a colleague realised some discrepancies in the script and the issue of a dress code for the team presentation was brought up6. Such concerns were clarified by email communication13, but unfortunately such enthusiasm was only shared amongst a few peers. Nevertheless, it was very satisfying to see that everyone had contributed something to the final presentation which was a sentiment to my effective delegation of roles14.
I felt that a certain member had not contributed much throughout the course and was continually seeking a minimalist approach which could have been detrimental to the team's performance. I voiced my opinions in her peer review form so she could improve in the future as the potential adverse consequences of a breakdown of communication within the MDT can be damaging to the patients care.
The roles conducted by the team members varied from communication, ethical issues and the role-play. Margerison and McCann (1995)15 constructed a teamwork model stating a successful team encompasses individuals with a variety of skills, hence fulfilling diverse roles. All the team members were, to differing extents, 'creators' - innovators - as we each contributed something constructive. I believe certain members whom had thought of the idea of a role-play were more creative and others whom had continually produced their contributions on time were deemed 'concluders'. Another individual whom had taken the responsibility of merging the slideshow together expressed her practical skills as an 'assessor', whilst another member helped to support me in my leadership role. Her efforts were invaluable in making by duties more proficient and constantly reminding me to book the library rooms for scheduled meetings. She was classified, according to the teamwork model, as an 'upholder'. Finally, the individuals involved in the role-play were 'concluders' due to their quality standards and 'reporters' because they were capable of incorporating prior knowledge to help answer questions following the presentation. I feel that I was a 'thruster' because as a democratic leader it was my duty to organise and motivate other members, whilst continually involving them in the decision making process.
After the presentations, we took part in a peer review exercise, where our observations of each others' performance throughout the course had to be 'reflected'. The irony of teamwork is that a team is made up of individuals. These individuals will have different experiences, knowledge, expectations and priorities. Thus it is important that our team developed a keen interest in the performance as a whole, as this will influence individual contributions. Amongst the majority of peer review forms, I noticed many positive comments ranging from being "knowledgeable on the subject of consent"8, "good at arranging ideas" and "has good delegation skills... ensures everybody has an equal role to play"14. This was extremely pleasing to learn because it illustrates that my fellow team members fully appreciated the effort that I put into the project. Also, my contribution to the presentation as a team player was also acknowledged stating I had "contributed the knowledge and understanding of capacity and consent... which helped to explain the patient's rights in our role-play... helped the nurses learn about the Gillick test, which until then we had no understanding of"16. I believe this statement portrays my effective communication amongst the team throughout the programme enabling the group to maximise our potential to work in an MDT approach.
Amongst the very few negative comments, a team member justifiably observed that I "was a bit quiet at the start of the IPE session"8. In retrospect, I believe I should have been more expressive and honest with my group and have confidence in making alternative suggestions ultimately benefiting the group. Furthermore, another team member felt I "could have taken more control/been more decisive so that people were clear of what to do"17. It was interesting to note that he/she had also written that I was "good at sorting out the details i.e. what exactly each person was going to go away and research"17. Nonetheless, I felt that I delegated the tasks suitably because I had ensured that each member understood and had ownership of their tasks for the next session. Although the issue had never been brought up nor had I been emailed of any confusion in the allocation of roles, I believe that I should have utilized the luxury of emailing each member clearly what they had to do.
From this experience, I have gained a lot of knowledge both on the issues regarding underage pregnancies as well as the skills required to work effectively in a team. My fellow members had enlightened me of the growing problem of teen pregnancies in certain boroughs around the capital and we all felt the government was failing this young generation. According to the article mentioned earlier, "The expansion of confidential contraceptive services for young people under 16"9 was the main causal factor. I learnt through an inquiry based learning approach the importance of effective clinical communication and ethical considerations in managing the issue. Furthermore, a fellow member also enlightened the group on the vital role of the sexual health centres in providing education and advice for the younger generation.
I have also discovered the challenges associated with controlling large teams of varying disciplines. Apart from the logistical constraints, each member of the team had their own schedule and hence the proposition of extra sessions was difficult to attain. However, many challenges and complications were dealt with very effectively via email13, thus eliminating the scheduling and logistical constraints in place. Coordinating nine members of a team demanded good organisational and most importantly time management skills. This is enormously beneficial for me because as I progress through my medical career, there is an increasing demand for efficient teamwork.
On reflection it is clear that our team worked very well together and expressed ourselves to construct an effective presentation of the chosen scenario. The Egalitarian atmosphere during the meetings was admirable, where every decision involved a vote of confidence. Nevertheless I feel as group leader I should have struck a balance between collective decision making and being more abrupt, as well as ensuring that all the tasks are being conducted well. Also in the future, fewer people could have presented the final task. A solution could have been to make a video for the role play, thereby freeing up more space for other members of the team on the stage.
Overall, the IPE programme has been an incredible learning curve which has provided an insightful experience as well as an understanding of the significance of effective communication between professionals. Lastly, this experience has emphasized my weaknesses, but I have appreciated that others may have different ways of working; different skills and knowledge, which in practice contribute to the patient's healthcare.