Qualitative Study of Interprofessional Collaboration in Radiation Oncology Clinics: Is There a Need for Further Education?

Abstract

Purpose:

Interprofessional education (IPE) is gaining recognition as a means of improving health care delivery and patient outcomes. A primary goal of IPE is improved interprofessional collaboration (IPC). The multidisciplinary team in the radiation oncology clinic requires effective IPC for optimal delivery of radiation therapy. However, there are limited data on IPE and IPC in radiation oncology. This qualitative study aims to characterize IPC in radiation oncology.

Methods and Materials:

Semistructured phone interviews were performed from June to August 2019 with radiation oncologists, nurses, dosimetrists, radiation therapists, medical physicists, and medical students across a single academic medical center and affiliated network sites. Interviews were recorded, de-identified, and transcribed verbatim. Resulting transcripts were analyzed using thematic analysis.

Results:

Seventeen interviews were performed with 4 radiation oncologists, 2 nurses, 2 dosimetrists, 4 radiation therapists, 2 medical physicists, and 3 medical students. Thematic analysis identified 4 themes: (1) management of the radiation oncology clinic, (2) potential impact of interprofessional training in radiation oncology, (3) current climate of interprofessional education in radiation oncology, and (4) creating an interprofessional training program in radiation oncology. Each theme elicited between 2 and 7 subthemes.

Conclusions:

From the analytical themes that emerged, it is hypothesized that misunderstanding professionals’ roles can lead to communication breakdown, which creates less efficient clinic management and disorganized patient care. Although other medical professionals shadow physicians during their training, physicians are not learning about other professions in the same way. Interviewees from each professional category recommend a formal shadowing program for radiation oncology trainees at the medical student or resident level. Having structured opportunities for IPE is important given competing demands of learners during medical student rotations and residency. This study suggests an unmet need for exposure of radiation oncology medical trainees to IPE with the ultimate goal of improving IPC in the radiation oncology clinic.

Introduction

Interprofessional education (IPE) is now recognized as a means of improving health care delivery and patient outcomes.¹ IPE typically involves students from 2 or more medical professions learning about, from, and with one another.¹ The Canadian Interprofessional Health Collaborative (CIHC) created a comprehensive framework for interprofessional training, citing interprofessional collaboration (IPC) as the ultimate goal of IPE.² The impact of effective IPC has been quantified in prior studies, showing decreased mortality in surgical patients,³ decreased clinical error rates in emergency departments,⁴ and improved quality of care in diabetes management.⁵ In response, graduate medical education accreditation bodies now include IPE as a core competency.⁶ A recent survey of residency program directors in family medicine, internal medicine, pediatrics, psychiatry, obstetrics and gynecology, emergency medicine, and surgery found that more than 60% of residency programs include IPE in their curriculum.⁷

Characterizing the effectiveness of IPE in health care is not a recent development. Prior work from Barr et al suggests using Kirkpatrick’s model of the hierarchy of learner outcomes to delineate the impact of IPE, with IPE outcomes classified into Kirkpatrick’s 4 levels.⁸ The first level characterizes the learner’s reaction and change of attitude toward IPE. The second level focuses on learning and the acquisition of knowledge related to interprofessional work and collaboration. The third level encompasses behavioral change of the individual learner, which ultimately translates to their interprofessional team. The fourth level then focuses on organizational change to the structure and process of the health care delivery, health outcomes, and patient satisfaction.

Considering the interprofessional team structure of the radiation oncology clinic, which includes radiation oncologists, nurses, radiation therapists, dosimetrists, and medical physicists, effective IPC is necessary for optimal delivery of radiation therapy. However, a recent literature review of current IPE initiatives in radiation oncology identified only 4 reports of radiation oncology IPE.⁹ There were insufficient data on the observed outcomes given the early stage of development of these initiatives. Thus, there is a need to characterize IPC in the radiation oncology clinic to guide further study of IPE and potential IPE interventions.

The primary aim of this study was to elicit qualitative reports through interviews of radiation oncologists, nurses, radiation therapists, dosimetrists, medical physicists, and medical students who had completed radiation oncology clerkships to assess IPC in radiation oncology. With a better understanding of the field’s IPC, a secondary aim was to characterize a need for IPE. This characterization was based on the CIHC framework and Barr et al’s IPE-specific interpretation of Kirkpatrick’s hierarchy of learner outcomes. Although radiation oncology’s small size as a specialty provides a unique opportunity to study how professionals’ knowledge of other professions’ roles affects clinic functioning, it was hypothesized that the small size of training programs may also present a challenge when creating IPE initiatives. Specifically, congregating students of multiple radiation oncology professions together for IPE would be logistically difficult. Therefore, a tertiary aim was to identify how radiation oncology professionals would structure an IPE curriculum with medical trainees as the learners.

Methods

Study participants and interview protocol

This project was determined as exempt by the University of Chicago Institutional Review Board. Interviews were conducted with radiation oncologists, nurses, radiation therapists, dosimetrists, medical physicists, and medical students specializing in radiation oncology. All medical professionals worked at a large urban academic medical center or an affiliated network site. This cohort of professionals was selected to capture stakeholders’ perspectives on IPC within radiation oncology. In addition, medical students were interviewed to gather information on IPC they witnessed during clerkships or away rotations in radiation oncology and any formal radiation oncology IPE training they received in medical school. Radiation oncology professionals were recruited via email. Medical students were recruited via Twitter. A tweet was composed inviting medical students to contact 1 author (D.W.G.) if they were interested in participating.

Phone interviews were conducted from June to August 2019 and lasted for approximately 30 minutes. An interview protocol was developed specific to each profession. Before the interview, participants were read a brief introduction explaining the concept of IPE and the purpose of this study. Interview protocols can be found in the Supplementary Material (Appendices E1–E6). Participants were asked about their exposure to formal IPE in their professional training. The participants discussed their knowledge of the roles of other professions in radiation oncology and reflected on the extent to which their role was understood by these other professions. Questions also probed whether the participants thought that IPC could be improved in their workplace. If improvements were suggested, the participants were asked to discuss how these changes could be implemented and how they would design an IPE curriculum to reflect the necessary changes. Interviews were conducted on the phone, recorded, deidentified, and transcribed verbatim, using the phone application Tape A Call (TelTech, South Amboy, NJ).

Data analysis

Thematic analysis was used to analyze interview transcriptions for themes related to IPC within radiation oncology and the need for further interprofessional training. Thematic analysis was chosen because of its flexibility in examining the perspectives of different research participants. The highly structured approach to data is helpful in summarizing key features of a large data set.¹⁰ Data saturation was approximated when there was sufficient quantity and quality of data, and any further data collection would not contribute new ideas.¹¹ The coding method then consisted of 6 analytical stages as described by Nowell et al. Phase 1 involved familiarization with the data. Phase 2 included initial coding of identified repeated concepts with ATLAS.ti software (Scientific Software Development GmbH, Berlin, Germany), using sentences and phrases as units of analysis. In phase 3, initial codes were coalesced into relevant themes. Themes were seen within 1 singular interview transcript or through the comparison of multiple transcripts. In phase 4, themes were discussed and pared down further by the analysis team (O.A.S., R.S.H., and D.W.G.), which included investigation of thematic outliers that challenged the legitimacy of a category. Phase 5 consisted of formally naming the resulting themes. Analysis culminated in phase 6, in which researchers examined the relationship between finalized themes, building and reporting hypotheses from thematic analysis of the data.

Results

Study participants

Demographic characteristics for participating radiation oncology professionals (n = 17) are listed in Table 1. Nine participants (52.9%) were female, with attending physicians and radiation therapists having the greatest professional representation (23.5% each). Professionals 0 to 10 years out of training (including medical students) made up the largest sample (47%) with the remaining participants spanning 11 to 40 years out of training. A majority of participants trained in the midwestern United States (82.3%).

Table 1.

Demographics of 17 interviewed radiation oncology professionals

	Number of participants (n = 17)	%
Sex
Female	9	52.9
Male	8	47.1
Profession
Attending physician	4	23.5
Nurse	2	11.8
Dosimetrist	2	11.8
Radiation therapist	4	23.5
Medical physicist	2	11.8
Medical student	3	17.6
Years in practice
Medical student	3	17.6
0–5	3	17.6
6–10	2	11.8
11–20	4	23.5
21–30	2	11.8
31–40	3	17.6
US region of training
Midwest	14	82.3
South	2	11.8
West	1	5.9

Summary of themes

Four main themes recurred throughout the interviews.

1. Management of the radiation oncology clinic

2. Potential impact of interprofessional training in radiation oncology

3. Current climate of interprofessional education in radiation oncology

4. Creating an interprofessional training program in radiation oncology

All themes and subthemes are displayed in Table 2. Each theme will be discussed in detail and supplemented with the voices of interview participants. The profession from which each quote was made is denoted using the following annotation: radiation oncologists are identified by MD#, medical students by MS#, nurses by N#, radiation therapists by RT#, dosimetrists by D#, and medical physicists by MP#.

Table 2.

Four prominent themes and associated subthemes from the complete interview data set

Themes	Subthemes
1 Management of the radiation oncology clinic	Communication Interprofessional collaboration Necessary improvements to interprofessional collaboration
2 Potential impact of interprofessional training in radiation oncology	Possible impact of interprofessional education on health care providers
	Possible impact of interprofessional education on patient care
3 Current climate of interprofessional education in radiation oncology	Exposure to interprofessional education in medical training
	Barriers to interprofessional education
	Exposure to interprofessional education in other professionals’ training
4 Creating an interprofessional training program in radiation oncology
	When to encounter interprofessional education in training
	What to include in an interprofessional education curriculum

Theme 1—Management of the radiation oncology clinic

Communication

Participants were asked to reflect on positive and negative aspects of clinic management. When asked what makes a clinic run most effectively, the idea of clear communication recurred. An attending physician noted:

Overall, the clinic runs smoothly when there is good communication across domains that addresses any sort of issues, as well as having protocols and algorithms for clinic and making those run in a way that kind of removes any ambiguity. (MD2)

Communication must occur smoothly within and between professional groups. As an example of effective interprofessional communication, participants who worked in 1 network clinic repeatedly mentioned “family meetings” implemented by a managing physician. A nurse stated:

In family meeting, everybody is invited, and everybody goes around the table and says, “What are your issues, and what are your issues?” I think [the managing physician] started it, so I would call [this physician] a pioneer in regard to really establishing a good relationship with all the [professions] within the department. (N1)

However, instances of poor communication surfaced as well. No matter which professions were involved, a lack of communication led to inefficiency. An attending physician detailed the ramifications of a breakdown in communication:

Basically, the clinic is not running very efficiently at all because then the nurse doesn’t know what you’re doing, I don’t know what they’re doing either and our expectations of each other are not fully understood so that makes for a not-good clinical setting. (MD4)

Interprofessional collaboration

Robust data were collected on the current status of IPC within radiation oncology. Collaboration was not always reported as favorable. Often, collaboration fell apart when professionals had a misunderstanding of one another’s roles in the clinic. A radiation therapist reported:

I feel like questions [physicians] throw at [radiation therapists] are a nursing or dosimetry question … then we have to reach out to the other professions and then we loop back to the doctor. I feel like we’re sort of the middleman. (RT3)

This roundabout method of communication initiated by the physician led to inefficiency. This inefficiency could then be exacerbated when abrupt changes needed to be made to a radiation treatment plan. A misunderstanding of professional roles would lead to miscommunication of what needed to be done, which ultimately created unnecessary stress in the clinic. This was demonstrated by 2 opposing quotes. The first from an attending physician:

The physicists or dosimetrists might not think that a tweak is clinically meaningful whereas a physician might think it could be clinically useful and thinks it’s important to spend the time to optimize the plan. (MD1)

Contrast the previous quote with this dosimetrist’s perspective, which states:

I would have physicians who would insist on trying, so I would just have to give up and make this impossible plan just to prove to them that it wouldn’t work. (D2)

This misunderstanding was paralleled by other professionals as well. The following quote demonstrates how confusion of the roles of nurses and radiation therapists caused conflict that translated to the patient-level:

A nurse should never give a patient a treatment time on a machine because that’s not respectful to the role of the radiation therapists because [radiation therapists] know this patient will take a half hour or we have to take films on the patient that day. (N1)

This nurse went on to say that a solution for this issue was mutual respect for all professionals’ roles within the radiation oncology clinic. Respect was a common theme woven throughout positive experiences with IPC. A medical student noted:

For the most part, I think everyone had a lot of respect for each other. Most times everyone recognized that everyone else can contribute something that they themselves can’t do and that was really inspiring to see how well everyone works together. (MS2)

Necessary improvements to interprofessional collaboration

Participants were then asked to reflect on how a clinic could be better run. As demonstrated by the following quote, communication between professions was a key area for improvement:

Communication needs to better. For example, if I evaluate some film that was taken and the patient wasn’t set up appropriately, I could actually speak with the therapist and explain what’s wrong and explain how that could impact the patient’s final outcome. (MD1)

Whether it was communication of treatment plan changes, communication of scheduling, or communicating to patients themselves, someone from every profession noted a need to improve interprofessional communication within the clinic.

Theme 2—Potential impact of interprofessional training in radiation oncology

Possible impact of interprofessional education on health care providers

After discussion of necessary improvements to interprofessional collaboration, interview participants were asked to hypothesize the potential impact of IPE on health care providers within the radiation oncology clinic. All participants stated that the effect of IPE would be positive. Physicians specifically noted that better IPE during training would make communication more efficient. An attending physician noted:

[IPE] may help me understand how to better communicate with the dosimetrists or physicists or whoever if I want something changed or improved. I guess having a baseline knowledge of what they’re currently doing or their current set-up would help me better explain what I want changed or what would make it better. (MD1)

Referring to Barr et al’s interpretation of Kirkpatrick’s hierarchy of learner outcomes, the physician’s improved understanding of another professional’s role represents a second level outcome of IPE. The improved communication on behalf of the physician represents a third level outcome. Using Barr et al’s model, the second and third level improvements would likely impact the day-to-day job of other professionals as well. A dosimetrist explained:

Sometimes physicians come in and ask for a very complicated plan. We on average ask for 1 week from sim to start date, and sometimes they’ll come in and ask for it in like a day or 2 turnaround. I think if there was a better understanding in any area then the request or the expectations are more realistic. (D1)

This sentiment was repeated by nurses, radiation therapists, and medical physicists, demonstrating how IPE can lead to behavioral change of the physician.

Possible impact of interprofessional education on patient care

One aspect that united all interviewed professions is their desire to improve patient care. Participants from all professions stated that IPE would improve a patient’s experience in the clinic. One medical student reflected on when he/she saw the best patient care, stating:

It was when the team was happy and cohesive and got along with each other. In order for that to happen, you have to have some understanding of what everyone does. (MS1)

To support this point, a radiation therapist hypothesized that structured IPE would increase patient comfort because of IPE’s ability to create better team unity—a fourth level outcome of Barr et al’s model. Level 4 classifies organizational change, and thus patient outcomes, as the peak of the hierarchy of learner outcomes in IPE. Specifically, a patient would experience a team working together for him or her. Attending physicians expressed the most skepticism about how large of an impact IPE would have on a patient’s experience.

Theme 3—Current climate of interprofessional education in radiation oncology

Exposure to interprofessional education in medical training

The attending physicians and medical students then discussed previous exposure to IPE in their training. One physician’s residency training included a formal rotation of interprofessional shadowing. The attending physician described:

We were required to be in physics for about a month and to work on the machine itself for a month, so I think my experience is pretty unique. (MD4)

This physician repeatedly noted the novelty of this particular program and its positive impact on this physician’s training. The physician suggested it provided a better understanding of what happens to the patient during the treatment phase of radiation therapy, allowing the physician to better prepare the patient beforehand and troubleshoot set-up issues when they arose. Conversely, all other physicians and medical students reported only optional interprofessional shadowing opportunities in radiation oncology, if any at all.

Barriers to interprofessional education in medical training

The informal structure of these interprofessional training programs created a significant barrier to participation as exemplified by the following quote:

I think what precludes trainees from doing [IPE] is to stand out and make a good impression for letters of recommendation. Any time I can spend with the physicist, while I may be enhancing my understanding of what they do, ultimately lacks in utility getting me what I want to get out of [my rotation]. I think maybe if it was a little more structured where it was literally built in. it wouldn’t be an issue because there are sometimes, unfortunately, competing demands on these rotations. (MS3)

The medical student continues to elaborate on an existing culture that treats these rotations as interviews rather than education experiences. Thus, what medical trainees want out of these rotations are letters of recommendation and the opportunity to connect with attendings and residents they may work with 1 day. This pressure remained at the resident level as well. An attending physician noted:

I think when residents go off on rotations that are not directly under physicians, the physicians resent it. … If the resident is sitting at the machine or with dosimetry, the attending may wonder where they are. (MD4)

When asked how physicians learned about other professionals’ roles, most cited their knowledge came from on-the-job collaboration rather than formal curricula.

Exposure to interprofessional education in other professionals’ training

The culture of remaining siloed within a profession does not persist in radiation therapy, dosimetry, and medical physics. Participants in these professions reported significant learning experiences when they were required to shadow other radiation oncology professions as part of their training program. A medical physicist noted the importance of seeing what a physician did on a daily basis:

The physician is more patient care directed. They’re looking at the whole case to help the person in front of them… and that helps me better understand what I need to do to further that goal. (MP2)

A dosimetrist noted a similar theme in his/her experience shadowing during training:

That’s how I learned of the flow of the clinic being right with people who are actually doing it. You know you could read the books about the treatments… when you have planned to put a wedge in to improve dose conformality and then you would go in the room you actually see what that would look like and where it went into the machine. It helped put the whole picture together for me. (D2)

Across all professions, a key takeaway from IPE was a better understanding and appreciation of their team members’ roles as stated by the following dosimetrist:

I mean [IPE] is super important. Everyone there is a team and you—especially as a student—you’re dependent on every person in that team, so it’s important in the training to acknowledge and appreciate that you’re a creating a relationship with all these people and that you need each other to get the job done. (D1)

It was noted that this attributed to a more collaborative practice because professionals could ask more informed questions of one another and streamline communication based on the understood goal of each profession.

Theme 4—Creating an interprofessional training program in radiation oncology

When to encounter interprofessional education in training

In light of their own experiences during training, participants were asked to think about how they would structure an IPE curriculum for medical trainees. All participants agreed that training would be well-served at the medical student and resident level—a need exists for both groups. However, some participants warned against implementing IPE too early in training. They believed it was important to have a clear understanding of one’s own role before attempting to understand the nuances of other professions.

What to include in an interprofessional education curriculum

When participants were asked what they would include in their IPE curriculum, a majority suggested some sort of shadowing program for radiation oncology trainees. Representatives from each profession noted the benefit of seeing firsthand what constitutes their day-to-day job. Radiation therapists suggested students spend time at the computed tomography simulator and linear accelerator to better understand what the patient goes through. Nurses wanted students to observe their psychosocial role in patient care in addition to the daily clinical tasks they perform. Dosimetrists and physicists both expressed a desire for students to shadow and actively engage with the treatment planning process. Although each profession urged students to shadow their own role, each profession especially called attention to the role of radiation therapists. For example, a physicist said:

[Residents] should definitely spend the day at the treatment machine. I mean literally spend the entire day there, and they’re not allowed to leave or work on notes, so they can see how long the therapists are waiting, or they can see how difficult it is to set up a palliative patient that you have to treat with all these fancy techniques, but they can’t even hold still. (MP1)

Similarly, a dosimetrist explained:

Have [residents] go to a machine and spend a couple weeks with the therapist after they learn to treatment plan. … It’s important to get an idea—it’s not just a video game on a screen. When I went to the machine with the therapist, that’s when it really came together. (D2)

At the most basic level, this dosimetrist is explaining a level 1 outcome from Barr et al’s model in which trainees experience an attitude change and appreciation for IPE and their colleagues in other professions.

Discussion

The primary objective of this study was to better understand the IPC taking place in radiation oncology clinics. Through semistructured interviews of radiation oncologists, nurses, radiation therapists, dosimetrists, medical physicists, and medical students, it is theorized that misunderstanding of professional roles leads to breakdowns in communication, which creates less efficient clinic management and disorganized patient care. This study revealed that although other professions shadowed physicians during their training, physicians were not learning about other professions in the same way. This suggests an unmet need for radiation oncology trainees to be exposed to more formal IPE.

These results are corroborated by a recent literature review, which found minimal examples of IPE within the field of radiation oncology. Of 1306 articles screened, there were only 4 reports of IPE. Reports with quantitative data demonstrated positive outcomes, and descriptive studies viewed IPE positively. Initiatives were either at the undergraduate level or for practicing professionals. There were no reports of IPE for graduate medical education.⁸ However, an opportunity exists to include structured IPE within didactic curricula for fourth-year medical students in radiation oncology clerkships¹² and first-year radiation oncology residents.^13,14 Building IPE into the medical student clerkship or introductory resident curriculum would address the barrier expressed by a medical student interview participant who said:

I think maybe if [IPE] was a little more structured where it was literally built into the rotation. it wouldn’t be an issue because there are sometimes unfortunately competing demands on these rotations. (MS3)

Interprofessional experiences are incorporated in the training of other radiation oncology professions already, such as cavity delineation workshops for radiation therapists,¹⁵ MBA courses on multidisciplinary leadership for medical physicists,¹⁶ and interprofessional conference attendance by radiation therapy and dosimetry trainees.¹⁷ An opportunity exists for medical residency program directors to look to their peers in other professions for successful and valuable IPE models.

It is imperative that other professions are included in the curriculum inquiry process to develop radiation oncology IPE for medical trainees. The idea of hierarchy has not yet been discussed but is underlying the data presented. For instance, in the Interprofessional collaboration section of theme 1, the opposing quotes between the physician and dosimetrist depict a misunderstanding of one another’s roles; however, it can also be analyzed under the lens of trust and professional hierarchy. As presented by Haddara and Lingard, improved IPC can be thought of as a utilitarian improvement in team efficiency and health care delivery, but it can also be thought of as a means for professional emancipation.¹⁸ Professional emancipation is meant to create empowerment for individual professionals, reducing medical dominance. Relating these ideas back to the opposing quotes of the physician and dosimetrist, perhaps if there had been improved IPC, there would have been more trust in the dosimetrist’s professional opinion or at least the ability for the 2 to debate on equal ground, giving the dosimetrist the sense of professional emancipation. However, even more powerful than theorizing how other professions may feel, an interviewed physician asked that these professionals be included in the creation of radiation oncology IPE:

I would ask the therapist to write their portion [of an IPE curriculum]. I would ask the nurse to write their portion, the physicist and dosimetrist to write their portion. Then what would be interesting is to have a roundtable discussion with all of the specialists so the students could ask questions about what they do and how they do it. Because, if you have the physician create [the curriculum], it’s going to be top down and one-sided. … I feel like if we had a curriculum created by those who actually do it, it might be more authentic. (MD3)

As mentioned in the Necessary improvements to interprofessional collaboration section under theme 1, improved collaboration comes from a culture of mutual respect. In designing an IPE curriculum, it will be crucial to include the knowledge and viewpoints of other professionals.

Therefore, all interview participants in this study were asked how they would structure a potential interprofessional curriculum for medical trainees. Most included a formal shadowing program in which medical trainees would learn directly from other radiation oncology professions through half- or full-day experiences in the clinic. The argument that medical trainees can be the “main learner” in IPE initiatives is made by contextualizing current radiation oncology IPE initiatives within the definition of IPE. The definition states that learners from multiple professions learn about, from, and with one another. Currently, the “learning with” aspect of this definition is not met because, as the data suggest, trainees from other radiation oncology professionals are engaging in shadowing and medical trainees are not. Thus, “learning with” does not exist until the loop is closed by IPE initiatives with medical trainees shadowing in the same way.

Medical trainees shadowing other professions circumvents the previously mentioned challenge of organizing IPE in a small field such as radiation oncology. Though not impossible, as exemplified by an image verification workshop for medical and physics residents,¹⁹ many academic medical centers with medical residency programs do not also have training programs for nursing, dosimetry, radiation therapy, and medical physics. For example, the large urban academic center of the present study only has a medical physics residency and radiation therapy clinical internships. There is no nursing school or dosimetry training program. Although all radiation oncology professionals exist in a continuing medical education context, this study specifically examined the undergraduate medical education (UGME) and graduate medical education (GME) levels. This was guided, in part, by interview data. Medical students and physicians were asked when it would be best to encounter IPE in their training, and almost all pointed to their training as a medical student on their radiation oncology rotation or early in their residency training. One student said:

I think just having more structure [of IPE training] across multiple university health systems and medical schools might ameliorate a lot of this discrepancy or gap-in-knowledge in the beginning of training before one embarks on their residency. (MS3)

The decision to focus on UGME and GME was also made from sociologic studies of professional identity formation. A recent guide for medical educators published by the Association of American Medical Colleges suggests the socialization needed to form a physician’s professional identity begins as a medical student.²⁰ It further elaborates that although medical education previously focused on the individual accomplishment of the physician, this is incompatible with modern practice that necessitates interprofessional collaboration. This idea parallels Haddara and Lingard’s themes of hierarchy and professional emancipation previously discussed. For this reason, it is important for medical trainees to understand the interprofessional nature of health care early in their training, which can be facilitated through formal opportunities for IPE in the UGME and GME setting.

There are limitations to this study that should be acknowledged. One limitation is that all interview participants, except for the medical students, work within 1 large, urban academic center and its network locations. Therefore, these results may not be generalizable to the views of radiation oncology professionals at large. Interview participants’ views may not be representative of other clinical settings, such as private practice or other geographic locations. Nonetheless, the themes elicited by this study can be used to help shape future IPE initiatives to improve interprofessional collaboration within radiation oncology. Additionally, the interviewed attending physicians are not directly involved in the creation of educational content for medical trainees. These participants were selected to better understand the perspective of the front-line clinicians on IPC and their personal experience with IPE. However, their viewpoint on IPE may not reflect that of an educator. For this reason, future research involves the inclusion of 2 important stakeholders—residency program directors and clerkship directors. Their viewpoint could provide information on the feasibility of IPE initiatives at the undergraduate and graduate medical education level.

In summary, this study elicited qualitative narratives about IPC within the radiation oncology clinic that suggest a need to improve IPC in radiation oncology. IPC is cited as the ultimate goal of IPE, as exemplified by the CIHC framework for interprofessional competency. CIHC highlights 6 domains as important in achieving this goal: (1) interprofessional communication, (2) patient/client/family/community-centered care, (3) role clarification, (4) team functioning, (5) collaborative learning, and (6) interprofessional conflict resolution. Although trainees from all health professions physically learning together may not be initially feasible in a small specialty such as radiation oncology, this does not mean that IPE initiatives should be abandoned completely. Using the CIHC framework in combination with data put forth by interview participants, it is advised that a preliminary curriculum be developed around CIHC’s third domain of “role clarification,” which can be satisfied through medical trainees shadowing other professions. Barr et al’s interpretation of Kirkpatrick’s hierarchy of learner outcomes can then be used in tandem to evaluate the IPE initiatives and better understand if learners are benefitting in the ways hypothesized by this study.

Conclusion

Study data suggest that radiation oncology IPE targeted at role clarification could lead to improvements in interprofessional communication and team functioning, both of which lead to the ultimate goal of improved IPC. Medical students going into radiation oncology and radiation oncology residents should be learning about the other professionals that comprise the radiation oncology care team. Thus, development of radiation oncology IPE initiatives is an important area of exploration for medical educators in radiation oncology.