Date of Award

2016

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Education

First Advisor

Stanley, Darren

Keywords

Case Study, Complexity Theory, Interprofessional Collaboration, Interprofessional Education, Scoping Review

Rights

CC BY-NC-ND 4.0

Abstract

Interprofessional education is an important means of improving health care (Barr, Koppel, Reeves, Hammick, & Freeth, 2008; Canadian Interprofessional Health Collaborative, 2010). Further, interprofessional education is becoming a recommended curricular component for gaining accreditation for many regulated health professional schools (e.g., Canadian Association of School of Nursing, Canadian Association of Occupational Therapists). Unfortunately, the evidence available to guide the design and implementation of interprofessional education is equivocal (Institute of Medicine, 2015). In an effort to improve the evidence base for interprofessional education, authors have suggested better use of theory in interprofessional education research (McMurtry, Rohse, & Kilgour, 2016; Reeves et al. 2011). Complexity theory has been identified as a useful theory to study interprofessional education (Hall, Weaver, & Grassau, 2013; McMurtry et al., 2016; Weaver, McMurtry, Conklin, Brajtman, & Hall, 2011). Complexity theory reflects how interprofessional learning is enacted in practice (Fenwick, 2012; McMurtry et al., 2016). In an effort to understand how interprofessional learning may occur, with the goal of contributing to the evidence base supporting interprofessional education, I used two approaches to study interprofessional education using complexity theory. First, I conducted a scoping review (Arksey & O’Malley, 2005; Levac, Colquhoun, & O’Brien, 2010) to determine how researchers have used complexity theory in health services research. Interprofessional education is a subset of health services research, and I used the findings from my scoping review in combination with the findings from my literature review to inform my case study. Second, I used a multiple case study (Yin, 2013) to explore how concepts of complexity theory—diversity and redundancy—occurred during interprofessional education with four groups of post-secondary health care students. Cases consisted of 3-5 students each and data was collected from cases using focus groups and researcher observations. Cases were comprised of interprofessional education using high-fidelity simulation. I categorized data using an apriori codebook (Crabtree and Miller, 1999) using diversity and redundancy. I then identified themes with each category using an approach described by Creswell (2007). I focused on diversity and redundancy because these concepts support aspects of complexity theory important for learning— specifically self-organization and emergence (B. Davis & Simmt, 2003). There were 44 studies included in the scoping review—27 were qualitative, 14 were quantitative, and 3 were mixed methods. Complexity theory was most used as a conceptual framework in studies. Case studies were most common and long-term care most studied. Relationships, self-organization, and diversity were the most common concepts of complexity theory used by health services researchers. Findings from the case study research showed that diversity acted as a foundation for interprofessional learning, a foundation for interaction and a disrupter to flow. Redundancy acted as a contributor to flow and a connector within interprofessional education. My findings demonstrate that complexity theory is being used in health services research in several ways and that it could be useful for exploring aspects of interprofessional education in health. Knowing that diversity and redundancy occur within interprofessional education in certain ways, and may support and impede interprofessional education by way of self-organization and emergence, educators may want to focus on how diversity and redundancy can be altered within groups of learners.

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