Interprofessional education interventions in undergraduate students of musculoskeletal healthcare professions: a scoping review protocol

Abstract

Introduction

Enhancing interprofessional education (IPE) fosters collaborative efforts among healthcare professionals specializing in musculoskeletal (MSK) care. This approach presents a valuable opportunity to address the pressing MSK disease burden in developing countries, with high prevalence rates and limited resources. While an abundance of literature on the various elements of IPE among healthcare students and professionals exists, shared contexts of practice of South African MSK disciplines are not currently developed through IPE at higher education level, establishing a need for South African formalised curricular IPE interventions with an explicit focus on undergraduate students of MSK healthcare professions.

Methods and analysis

The intended scoping review protocol is guided by the framework set out by Arksey and O’Malley, where the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will guide the process of reporting. English sources (qualitative and quantitative methodological studies, conference papers and proceedings, systematic reviews, grey literature, unpublished materials, theses and dissertations) from the electronic databases PubMed, Scopus, ERIC and ProQuest with no date restriction will be included. A researcher, an independent reviewer and research librarian will search and extract data from abstracts and full texts for this scoping review, where any arising disagreements will be resolved by discussion. Reference lists of relevant literature will be scrutinised. Relevant literature will be recorded on a referencing software and deduplicated. The data collection will take place between May and October 2023. The findings will be reported narratively with the use of tables.

Ethics and dissemination

This scoping review does not require ethical approval as all literature used already exists in the public domain with no involvement of human participants. The findings from this planned review will be submitted to peer-reviewed journals and will be presented at higher education conferences. This scoping review protocol was registered on Open Science Framework with the registration osf.io/c27n4.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• This scoping review will form part of early insights into the pragmatic implementation and use of interprofessional education interventions specifically among students belonging to musculoskeletal (MSK) healthcare domains thus providing a unique MSK context.

• The methodology that will be used for this scoping review will be guided by the seminal work of Arksey and O’Malley which will allow a clear and transparent approach that can be reproduced.

• This scoping review will use a qualitative data analysis software. This tool will allow for the management, coding and categorisation of an expansive range of literature.

• Considering that only English sources will be included, there may be lessened generalisability with the potential for bias.

• This scoping review protocol indicates that quality appraisal of sources will not be performed as this is not a requirement of a scoping review.

Introduction

Healthcare systems aim to provide comprehensive and efficient care to address the specific and complex needs of the populations and diseases that they manage. These health systems are usually comprised of diverse health professionals from numerous disciplines that collaboratively seek to provide patient-centred care that is responsive to both current and emerging health issues. One such emergent concern is musculoskeletal (MSK) healthcare where differing disciplines interconnect to provide a common focus in the treatment and management of MSK conditions.^{1 2}

MSK conditions, with its excessive prevalence rates affecting approximately 1.71 billion people globally, contribute significantly to chronic ill health.^{3 4} The multimorbid nature of MSK conditions increases with age and tends to be more pronounced in regions of low to middle socioeconomic status causing substantial burden on already strained health systems.^{4 5} The burden of MSK conditions on society is amplified in developing countries, such as South Africa, where associated risk factors are rampant and MSK care and prevalence research are often not prioritised.^{6 7} In the African health context, health systems are challenged by more critical medical conditions, such as malaria, HIV/AIDS and tuberculosis, with severe shortages of health workers, health systems that are ill-equipped and disproportionate health policies.^{6 8}

Most of the available literature on the prevalence of MSK conditions in South Africa focus on work-related or occupation-related MSK disorders, with an emphasis on lower back pain⁷; however, preliminary studies indicate that 49.9% and 27.7% of a sample of 514 South Africans in 2018 reports moderate to severe chronic MSK pain, respectively.⁹ Prevalence of lower back pain in Africa has been shown to be 47%¹⁰ with an 18.1% prevalence for chronic lower back pain in Kwa Zulu Natal, South Africa.⁷ An urgent need for the development and implementation of evidence-based strategies to address the overwhelming burden of MSK conditions in the healthcare systems across the African continent has been identified.³

One type of educational strategy in which the burden on health systems associated with MSK conditions could be alleviated is with interprofessional collaborative patient-centred practice. Interprofessional practice (IPP) is a model of healthcare delivery in which healthcare professionals from different disciplines work together to provide coordinated care that is centred on the needs and preferences of the patient.¹¹ IPP aims to improve patient outcomes by enhancing communication, collaboration and shared decision-making among healthcare professionals¹¹. This collaborative practice, would need to be informed by interprofessional education (IPE) in undergraduate healthcare training, and is a global recommendation by policymakers.¹² IPE is defined, in the context of this study, as ‘students from two or more professions who collaborate to learn with, from and about each other’ ¹³ with the objective of creating awareness among different professions, increase an understanding of how to work in interprofessional collaborative teams by developing communication skills, establishing respect between health professions, eliminating negative stereotypes and incorporating patient-centred care values.³

These types of inexpensive IPE approaches are fundamental to the South African MSK healthcare system to facilitate and combine available resources, especially considering high prevalence MSK conditions often do not necessitate advanced and costly medical devices, facilities or medications and mostly require South African MSK healthcare providers to effectively integrate the available manpower and practice habits.^3–15 However, based on our literature search, majority of the available literature on IPE is reserved for medical and nursing professions and has not been further explored in the context of the other various complementary professions that address MSK healthcare, where there is an increasing need to deliver accessible care to patients with MSK complaints. Several of these South African healthcare service providers that offer services to assist in the alleviation of current MSK health services delivery include chiropractors, podiatrist, biokineticists, physiotherapists and orthopaedic specialists.^16–19 It stands to reason then that interprofessional collaboration between students of MSK-specific professions has the potential to optimise the response of quality patient-centred care to the MSK burden with minimised use of limited resources in developing countries, establishing the rationale for this scoping review.

Some South African higher education institutions, with health science faculties, have incorporated IPE initiatives²⁰; however, there still largely exists challenges in successfully incorporating formalised IPE training into health sciences curricula rendering IPE rather lacking in curriculum in health science faculties, with even a greater absence in MSK curricular, across South African Higher Education Institutions. This absence of IPE practices in South African health science curricula, paired with the recommended need for further investigation into the associated challenges of IPE programme implementation and evaluation in universities of specifically developing countries,²¹ necessitates an investigation with a focus on MSK IPE interventions to potentially ease the MSK burden documented in South Africa. This established the need to interrogate the current global literature in the form of a scoping review which will go on to inform further investigations on implementing and evaluating IPE interventions in a Health Sciences faculty at a South African higher education institution involving students of MSK healthcare professions.

The preliminary search of PubMed and Scopus did not retrieve any on-going scoping or systematic reviews on the selected topic, although a number of relevant peer-reviewed publications were identified.^12–18 A 2021 study aimed to create an interprofessional experience for dental and chiropractic students where core competencies for each discipline were focused.²² A 2019 study investigated the impact of combining massage therapy and surface anatomy learning for medical students.²³ Another 2019 study investigated a collaborative interprofessional approach to a clinical setting between medical, orthotics and prosthetics students.²⁴ In a 2018 study, researchers created a team-based learning approach to use an interprofessional ultrasound session to improve anatomical knowledge between medical and physical therapy students.²⁵ A 2016 study, aimed to incorporate an interprofessional competency-based curriculum between medical and physiotherapy students.²⁶ Another 2016 study implemented a MSK education week between internal medicine, physical medicine and rehabilitation, and orthopaedic surgery residents and students.²⁷ These studies indicate that many of the interprofessional literature focusing on MSK healthcare are based on medical students with not even one review of all these studies that would be able to provide a mapping of what has been done and how these IPE activities have been implemented in MSK healthcare education. Further interrogation of the literature indicated one pertinent realist review where the mechanisms of interprofessional health education were reviewed to assist with the improvement of collaboration in South Africa. This review presents the ‘infrastructure, resources, management, stakeholders’ attitudes, teamwork and educational principles’ associated with IPE in both developed and developing country settings. This realist review provides a broader context of IPE, that is different to this proposed scoping review, in that there is now a targeted investigation on already performed MSK-focused IPE interventions with only the involvement of MSK health professions²⁸ (Maree, p1).²⁹

The aim of this scoping review is to peruse evidence from published and unpublished works to identify, characterise and summarise works on IPE interventions among undergraduate students of MSK healthcare professions.

Review question(s)

The central research question that will steer this scoping review is ‘What existing literature, is available on IPE intervention implementation among students from MSK healthcare professions globally?’

The following subquestions were further identified:

1. To identify the types and combinations of students of MSK healthcare professions where IPE interventions have been implemented at undergraduate level.

2. What are the specific intervention approaches regarding content, type and detail of delivery that have been used in former research studies that involved IPE interventions in students from MSK healthcare contexts?

3. What is the nature of evidence relevant to the evaluation of the IPE intervention offered in the context of MSK healthcare students?

Methods

This scoping review of the literature protocol is to report on IPE interventions between students from healthcare professions with a focus or specialty in the MSK system. A scoping review method was favoured as it allows for the review of different forms of literature, such as conference papers and proceedings, theses and dissertations and grey literature, in a broader area of relevance to profile what exists and show where research gaps lie.²⁹ The planned scoping review will be undertaken to fulfil the Arksey and O’Malley prescribed methodology for scoping reviews.³⁰ The guidelines offered by Mak and Thomas that further build on the guidelines of Arksey and O’Malley were also incorporated, where relevant, in the steps necessary to conduct a scoping review.³¹ This scoping review will be in check with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).³² The PRISMA-ScR plays a key role in ensuring that the scoping review is undertaken in a manner that is transparent, complete and rigorous allowing the review to be replicated.³² Quality appraisal will not be implemented in this review as we aim to chart heterogenous research forms in this area of interest, thus the reliability of extracted data cannot be remarked on.²⁹

Inclusion criteria

This study will use the Participant/population, Concept, Context framework to align the research objectives with the selection of studies. This framework also informed the inclusion and exclusion criteria.^30–33

Participants/population

This review will consider studies that include any undergraduate student belonging to a MSK healthcare profession in a higher education setting. These domains can include students from the following MSK healthcare professions: chiropractic, physiotherapy, podiatry, biokinetics, osteopathy and orthopaedic specialists.

Concept

This scoping review will take into consideration studies that document the implementation of an IPE intervention or activity pragmatically among undergraduate students from MSK healthcare professions within the higher education setting. In this context, an education intervention would be defined as the support provided to students to gain skills taught in an educational system and addresses functional, academic, cognitive, behavioural and social skills.³⁴

Context

This review will consider studies that have implemented and/or evaluated IPE interventions in the higher education setting among students belonging to any healthcare profession with a specialty in the MSK system.

Identifying a team

Mak and Thomas recommend that the composition of the team members undertaking a scoping review be thoughtfully considered to allow for the competent skills by the team to make a valuable contribution to the field of interest.³¹ It is advised that the team be comprised of a content expert, an individual who has experience in undertaking a scoping review and a librarian to assist with the phase of literature search.^{31 35} This scoping review has preidentified team members who meet these requirements.

Types of sources

For this scoping review, the researchers will examine published, peer-reviewed, quantitative, qualitative and mixed methods study designs for inclusion. Systematic reviews, unpublished literature, grey literature, opinion papers, conference papers and proceedings, institutional and government protocols or guidelines, theses and dissertations will be deemed for inclusion in this proposed scoping review. Studies or literature from all countries will be considered. Prospective studies will not be limited by geographical location. Articles not published in English will be disregarded. All literature conforming to the inclusion criteria will be included. No date restrictions will be enforced, to allow for the maximum number of works to be appraised.

Search strategy

A pilot of potential search strategies was done to check for suitability on the PubMed and Scopus databases, with the assistance of an experienced research librarian, where selected keywords such as IPE, health professions students, allied health students, healthcare students, medical students or MSK and their possible synonyms were used.³⁶ The librarian will be consulted throughout the search phase of this scoping review, to assist with generating and refining the search strategy.³³ For recording purposes, a table was populated detailing the electronic database pilot searches (online supplemental appendix 1). The initial search also indicated no other similar and current scoping reviews. This took place in May 2023. The search strategy will be adapted according to the most relevant terminologies found in the titles retrieved in the pilot search, one example of this would be to not include specific MSK health professions as most titles do not define which professions were included. Electronic database searches of English literature, irrespective of the study design and year of publication will be done.³⁷ The following databases will be included: PubMed, Scopus, ERIC and ProQuest. The PubMed and Scopus databases were selected as those offer a comprehensive range of English-language peer-reviewed sources in the field of health education and can provide sufficient coverage of relevant primary research. The ProQuest database was selected to identify relevant grey literature, conference papers and proceedings and theses and dissertations. The ERIC database was selected as it provides access to comprehensive education research. Reference lists of the selected literature will also be scrutinised to identify further relevance of other works. This took place from June to September 2023.

Study selection

Citations and their respective abstracts of identified literature of relevance following the electronic searches will be imported, organised and recorded into Excel by the primary researcher. Excel software will be used to efficiently organise and screen abstracts where duplicates can be identified and can allow for a blinding process for reviewers. Following this, the included works will be exported into a reference management tool.³¹ Individual Excel document copies with the titles and abstracts will be screened by the researcher and an independent reviewer, through a process of voting, to assess if the works meet the inclusion criteria. A final combined summary will indicate the votes and highlight any disparities. A third independent reviewer will be available to discuss and resolve any disparities or conflicts during each stage of this scoping review. Once the final list of selected titles and abstracts is compiled, the full texts of each title will be retrieved and imported into Mendeley V.2.74.0 (Mendeley, Elsevier, Netherlands). At this stage, duplicates will be removed. The full texts of the selected titles will be transferred to the programme Atlas.Ti (V.8, ATLAS.ti Scientific Software Development, Berlin, Germany) to be further assessed for relevance according to the inclusion criteria and for analysis. In the event that papers do not satisfy the inclusion criteria, justifications for these will be detailed in the scoping review. The full and final results of the search will be described in the scoping review and be presented in a PRISMA-ScR) flow diagram.³⁸

Data extraction

A data extraction tool adapted by the primary researcher and an independent reviewer specifically a Data Charting Form³⁹ (online supplemental appendix 2) will be used to document all extracted data from the included literature. The data extracted will include specific details that include the title, author names, date of source, publication year and type, study design, keywords, abstract screening for appropriateness, study setting and population, reported benefits, reported limitations, conclusion, most significant findings, and findings relevant to the review questions. Further to this, extracted data will include the types of clinical learning environments used, the health professions that the involved students belonged to, stipulated learning outcomes, evaluation of the intervention and any measurement tools used.⁴⁰ The form will be pilot tested by the researcher and research librarian to ensure consistency.²⁹ Any modifications made to the data extraction tool will be stated in the scoping review. Discrepancies between reviewers will result in discussion or the involvement of a third reviewer. This will take place in September 2023. Once data extraction is complete, charting of the data will commence where data are both synthesised and interpreted.³⁷

Data analysis and presentation

ATLAS.ti, a qualitative software, will be used to arrange the data collected from the literature extraction to align with each research question namely student cohorts, details on intervention delivery and evaluation.⁴¹ Further to this, material from the collected articles will be scrutinised and coded, code will be used to develop groups of code to create eventual themes that mostly reflect the text³¹ relative to the identified research questions. The creation of codes will be iterative directed by the data analysis after which codes will be categorised to ascertain patterns in the literature.³¹

The data created on the ATLAS.ti software will then be used to produce a narrative summary communicating the findings of the scoping review and will be presented in a tabular format where commonalities will be reported, according to the finding’s relevance to the objectives and research questions set out for this scoping review.⁴²

Patient and public involvement

This prospective scoping review focusses on undergraduate students in higher education settings and does not have patient or public involvement.

Ethics and dissemination

As this proposed scoping review does not involve any participants and uses literature that is available publicly, ethical approval is not applicable. Important findings will be submitted to appropriate peer-reviewed journals in the form of a scoping review. These findings may also be presented at relevant education conferences. While there is extensive literature available on IPE implementation, this review has the potential to provide context-specific insights into the pragmatic use of IPE interventions that are focused on MSK healthcare involving undergraduate students of MSK healthcare professions, which currently poses a gap in the literature. The information gathered in the scoping review could be used to inform curriculum at higher education institutions offering MSK health education.

Ethics statements

Patient consent for publication

Not applicable.