A model of multidisciplinary professional development for health professionals in rural Canterbury, New Zealand

KEYWORDS: Continuing professional development; rural

Pegasus Health Charitable Limited is a Primary Health Organisation in Canterbury that is contracted by the Canterbury District Health Board to provide continuing professional development for primary care clinicians in the region. Each year, six topics of current interest are developed by the Pegasus Health Clinical Quality and Education Team, with external clinical input from relevant experts. Topics are delivered using a peer-led Small Group model with a trained leader who facilitates discussion. Starting with general practitioners (GPs) in 1992, the model evolved to include Small Groups for practice nurses in 1998 and community pharmacists in 2010, with nurse practitioners included in GP Small Groups since 2016. However, clinicians based in rural settings have generally found it difficult to participate in Small Groups because of the distances involved in travelling to the meetings. Rural practitioners face more difficulties in accessing continuing professional development programmes than their urban colleagues.^1–6

An initiative by the Pegasus Clinical Quality and Education team aimed to provide more satisfactory and accessible professional development for these rural areas. Three new groups were proposed: in Kaikoura, Rotherham/Hanmer Springs and Amberley/Cheviot. All except Amberley are more than 100 km away from Christchurch city. Each area has a unique local context and mix of health professionals who might want to participate in continuing education. It was not feasible to duplicate the urban model of separate Small Groups for each discipline because of the low numbers of health professionals in these areas and the geographical distances between them. Additionally, clinicians in rural settings indicated they preferred the multidisciplinary approach that more closely reflected the way they practised.

Before implementing a new model of Small Group professional development for rural health professionals, we wished to learn from the multidisciplinary Small Group that was already operating at Oxford in North Canterbury (54 km from Christchurch). It had originally been established on the initiative of a local GP who merged the materials provided by the Pegasus team to create a multidisciplinary session. In addition, all participants received the background material developed for their own discipline.

The Clinical Quality and Education team developed a SurveyMonkey® (San Manteo, CA, USA) questionnaire (see Appendix 1). It was distributed by the GP group leader to 14 regular attendees of the Oxford Small Group at the end of August 2016 and remained open until the end of the first week in October. The anonymous questionnaire was designed to elicit opinions about the effect of the multidisciplinary format on collaborative working and patient care, as well as whether access to professional development programmes had improved. The analysis of quantitative data was done through SurveyMonkey®; responses to the open questions were analysed separately.

There was an 86% (12/14 people) response rate to the survey. Attendance records showed that this number corresponds closely to the core group of health professionals who regularly attended the multidisciplinary meetings.

All respondents agreed that the multidisciplinary group worked well:

The most obvious example is the relationship with the Pharmacy. The input they provide in conjunction with the knowledge we have of patients have allowed excellent patient centred decisions to be made (Participant 6).

Eleven respondents made comments. They noted that perspectives from all disciplines were now incorporated in decisions about caring for individual patients and that good team work had resulted in a more consistent approach to patient care. Group discussions in a relaxed atmosphere meant that collective decisions were carried through into practice change, further reinforcing relationships and team work.

Most respondents indicated that they had made specific changes to their practice as a direct result of attending the group, and some had revisited the changes to assess their effect:

I have reduced codeine prescriptions [as a result of] the personalised feedback. Also, we have changed how we do back-pocket scripts. I know nurses are starting to introduce the idea to acute patients that they won’t necessarily need antibiotics (Participant 1).

Other improvements included the formulation of team protocols for consistent patient follow up and increasing referrals to the Green Prescription programme. The overall theme of the comments was the increased consistency of care across medicine, nursing and pharmacy that had resulted from the multidisciplinary format, underpinned by the quality of the content prepared by the Pegasus team. Together, these provided a high level of confidence that Oxford patients had ‘consistent access to updated best practice’.

All respondents agreed that the multidisciplinary group had improved their access to professional development and their incentive to attend. Moreover, it provided a forum for staff to meet together even if their working hours did not coincide:

We don’t have travel time or costs of going elsewhere. As a group, we are able to have a more relaxed discussion afterwards. It forms a good opportunity to get together outside of work hours, reinforcing the team approach of our practice. This is particularly of benefit as we all work part time and don’t necessarily see each other (Participant 2).

Most agreed that the multidisciplinary content was sufficiently relevant for them, but two respondents would have welcomed more that was specific to their own discipline. The primary disadvantage noted was the potential to become inward looking without exposure to fresh ideas from other practices. They also observed that while meeting together as a practice promoted good discussion, it also had the potential to silence an individual if their ideas did not align with those of their colleagues. No instance of this happening was reported.

The survey results showed that the multidisciplinary group was considered to have improved team work and interdisciplinary communication, and benefitted patient care. Access to professional development had also improved, with value being put on both the high-quality content of the formal Pegasus sessions and the opportunity for the part-time staff to meet socially outside working hours. This was consistent with a recent study in a rural Australian primary care practice that found that both formal and informal contexts contributed to inter-professional working and learning.⁷

There was some suggestion that the increased access may have been at the expense of not always delivering content that was specific and relevant to each profession. This may be a result of the multidisciplinary format, but the Small Group programme was never intended to cover all professional development needs. All health professionals, both urban and rural, would normally complement their attendance of the Small Group programme with education in other forms, such as conferences, lectures and short courses.

A multidisciplinary approach is considered essential for addressing the rising incidence of chronic disease in ageing populations and ensuring adequate future health.^8–10 However, longstanding cultural behaviours, funding and organisational models, and lack of understanding of the roles other people perform remain barriers to working collaboratively.^6,11–13 Multidisciplinary learning is a crucial element in overcoming these barriers.^8,10,14 Theoretical frameworks and guidelines for competencies are available but practical examples, especially in primary care, are limited.^15–17 Rural general practices tend to be ahead of their urban counterparts in the adoption of multidisciplinary teamwork as it allows clinicians to manage workloads more effectively, provide reciprocal support to one another, and deliver more integrated care to patients.^1,4,7,18 Mutual understanding and trust is also promoted, which in turn contributes to more patient-centred care.^6,7

The more advanced collaboration of rural practices is recognised as being valuable for student teaching and learning, with rural placements included in a range of health professional training curricula.^7,18,19 The professional development needs of qualified staff in rural practices do not appear to have received much attention, despite the known difficulties they face compared to their urban colleagues.⁴ Aside from reports of one-off courses²⁰ or networks developed for treating a specific condition,⁴ we were unable to find any programme similar to ours where rural health professionals from a range of disciplines had access to an ongoing structured programme of professional development.

This was a study of one group of rural primary care practitioners in one area of Canterbury and is not necessarily representative of other areas in New Zealand. Because of the small number of participants and the anonymous nature of the survey, we were unable to provide any analysis of participants’ ages, gender or professional affiliation.

The survey results confirmed that the multidisciplinary group model is workable and valued in rural areas. All three of the proposed new multidisciplinary groups are now active with trained peer Small Group leaders. Additionally, the Clinical Quality and Education team of Pegasus Health has now formalised the multidisciplinary format and has taken over editing the educational material so that quality, consistency and relevance for all disciplines is maintained. We believe that our programme is breaking new ground and may be unique in providing evidence-based continuing professional development for health practitioners in a multidisciplinary setting. We expect to report further when the new groups are more established.

None.