Interprofessional Rural
Preceptorship with Nursing and
Medical Students
A clinical preceptorship initiative:
Dr Deirdre Jackman, Dr Olive Yonge, Dr Florence Myrick, Faculty of Nursing, University of
Alberta
Dr Jill Konkin, Dr Fred Janke, Faculty of Medicine & Dentistry, University of Alberta
Jim Cockell, Research assistant
Funding
This study was funded by the Provincial
Government of Alberta.
Additional Funding was provided by
Covenant Health
Study Purpose
• Preparing students to learn competencies in
their respective disciplines
• learning to work collaboratively within
complimentary partnerships
• increasing awareness, appreciation, exposure
to rural health professional teams/settings
Assumptions
Health Care in Canada is a Universal
right
• Rural populations are entitled to health care
regardless of :
• Geographic location
• Age
• Socio economic status
Assumptions cont
• Interdisciplinary teamwork in the rural health
care setting indicates that in highly
functioning rural communities physicians and
registered nurses work together as a team.
• The uniqueness of the rural setting makes
working together more likely and more
effective.
Rural Context
Rural Population
• 6.3 million people or 18.9 % of the population
• Provide agriculture and natural resource
sustainability
Rural Context cont
The Number of Registered Nurses in
Rural/Remote Regions
• The number of registered nurses working and
living in rural/remote regions dropped from
17.9% to 13.7%
• The vast majority of this drop took place
between 2006-2009
Rural Context cont
Physician Numbers throughout Alberta. As
of 2011 in Alberta there were:
• 123 physicians per 100,00 population in the Edmonton zone
• 119 physicians per 100,000 population in the Calgary zone
• 97 physicians per 100,00 population in the south zone
•
92 physicians per 100,00 population in the central zone
•
81 physicians per 100,00 population in the north zone
State of Knowledge
• Evidence indicates that patients’ health
conditions improve with rural interdisciplinary
care
• An interdisciplinary approach leads to better
environments, decreased workloads, cost
benefits and increased efficiency
Preceptorship
• Traditionally preceptorship involves the one to one
pairing of a discipline specific health professional with
a student
• Preceptorship provides a well established clinical
model for high quality teaching and learning outcomes
• Physicians and RNs who teach ( preceptor) are known
to be happier with their work and more engaged in
providing quality care
Interprofessional (IP) Practice
Working Together for Health
World Health Report 2006
• Shift from tertiary hospital to patient centred, home
based and team driven care
• Increasing incidence of chronic conditions
• Core competencies include: patient centred care,
partnering, quality improvement, information and
communication technology and a public health
perspective
Interprofessional Practice cont
WHO: Framework for Action 2010
The World Health Organization recognizes interprofessional collaboration in
education and practice as an innovative strategy that will play an
important role in mitigating the global health crisis.
Interprofessional (IP) Rural
Preceptorship
• Provide students with a formal interprofessional (IP) collaboration
in a rural clinical setting
• Institute an up-steam IP clinical opportunity prior to graduation
• Facilitate IP learning using educational modules during the
preceptorship [ 1)IP collaboration and communication for health
care professionals; 2)Today's learner; 3)Rural context; 4) Roles and
responsibilities in nursing and medicine practice]
• Enhance rural IP exposure to contribute to recruitment ands
retention needs in rural settings
Research Question
• “What is the social psychological process
involved in a preceptorship that is specifically
designed to foster interprofessional
engagement of medical and nursing students
in the clinical setting?”
Research Design
• Grounded theory

specifically Glaserian
Data Collection
o Sample
–
–
–
–
–
–
three nursing students placed in the rural setting.
four medical students placed in the rural setting
three rural nurse manager preceptors.
four rural medical preceptors
one nursing faculty member
nursing and medical administrators.
• Setting and Population
– The rural setting included a larger acute rural hospital and community centres
( medical clinic, PCN, long term care facility)in Alberta.
– The population for this study included key members of the interprofessional
rural preceptorship.
Procedures
 Data collection comprised the following:
a)
b)
c)
d)
e)
Individual semistructured interviews.
Focus group interviews
Memos, researchers’ journaling, field notes
Computer program coding.
Secondary data sources including any
documentation appropriate to the study,
documents such as literature, curriculum/course
outlines, students reflections, self evaluations.
Data Analysis
• Substantive coding
• Theoretical coding
• Memoing
Rigor
• Creditability
• Fittingness/transferability
• Auditability
• Confirmability
Ethical Considerations
•
•
•
•
Ethical Approval
Informed Consent
Confidentiality
Anonymity
Findings
THE OVERALL THEME
‘Committing’
to interprofessional learning in the
rural setting
Includes the key elements of:
•
seeking opportunities to promote authentic interprofessional
learning
• protecting the time in order to attend to interprofessional practice
• focusing on the patient in a rural teamed approach
Seeking opportunities to promote
authentic interprofessional learning
The psychosocial process involved in seeking opportunities included:
•
•
•
•
•
•
•
•
•
•
•
•
•
A relational commitment (students, preceptors, staff)
It’s a journey ( students, preceptors)
Trusting the journey
Self direction ( students)
Motivation( students)
Attitude ( students, preceptors)
Committed to roles, learning ( students and preceptors
Engaged ( students and preceptors at times)
Confidence building related to individual roles responsibilities
Additions/advantage to learning about the other and self ( students)
Take the best of the traditional and combine with IP ( students, preceptors).
Building on traditional preceptorship ( students, preceptors)
Allowing student some scheduling flexibility and self scheduling for learning (
students, preceptors)
Protecting the time in order to attend to
interprofessional practice
The psychosocial process involved in protecting time included :
• Carving out time
• Scheduling in advance
• Planning weeks before
• But planning on the day, hour, moment ( all needed)
• Rural setting provides supportive environment
• Support IP as worthwhile
Focusing on the patient in a rural teamed approach.
The psychosocial process involved in focusing on the patient in a rural
context included:
•
Prioritizing face to face interaction as a central component to collaboration and communication
•
We’re a team ( staff and students)
•
Prior to this experience we (students) lived 2 separate lives
•
I know who they are ( students)
•
Not just a uniform but a person ( students)
•
I seek them out ( students, staff)
•
Interacting is better than reading a chart ( students, preceptors)
•
Additions/advantage to learning as a holistic approach to patient care
•
Increases patient care outcomes ( students, preceptors)
•
Staff role modeled IP behaviors ( students)
References
British Columbia Medical Association. Working together: Enhancing multidisciplinary primary care in care in BC (October 2005).
http://www.bcma.org
Canadian Institute for Health Information (CIHI). Regulated Nurses: Canadian trends, 2007 to 2011. Ottawa: CIHI: 2011.
Canadian Institute for Health Information (CIHI). Supply, distribution and migration of Canadian Physicians, 2010.Ottawa: CIHI: 2002.
Canadian Institute for Health Information (CIHI). Supply and distribution of Registered Nurses in rural and small town Canada. Ottawa:
CIHI: 2002.
Charmaz, K. (2000). Grounded theory: Objectivist and constructivist methods. In N. K.Denzin Y. S. Lincoln (Eds.), Handbook of qualitative
research (2nd ed., pp. 509-536). Thousand Oaks, CA: Sage.
Chaulan, T., Jong, M., & Buske, L. (2010). Recruitment trumps retention: Results of the 2008 CMA rural practice survey. Canadian Journal
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Jackman, D (2011). How the relational process shaped rural preceptorship. Unpublished Dissertation, University of Alberta, Edmonton, AB.
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1543-1549.
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Interprofessional Care, 26(4), 261-268.
World Health Organisation (2010) Framework for Action on interprofessional education and collaborative practice