scholarly journals Interprofessional education in geriatric medicine: towards best practice. A controlled before–after study of medical and nursing students

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e018041
Author(s):  
Sanja Thompson ◽  
Kiloran Metcalfe ◽  
Katy Boncey ◽  
Clair Merriman ◽  
Lorna Catherine Flynn ◽  
...  
Keyword(s):  
Medical Students ◽  
Nursing Students ◽  
Professional Identity ◽  
Interprofessional Education ◽  
Geriatric Medicine ◽  
Control Group ◽  
Joint Learning ◽  
Interprofessional Learning ◽  
Roles And Responsibilities ◽  
Before And After

ObjectivesTo investigate nursing and medical students’ readiness for interprofessional learning before and after implementing geriatric interprofessional education (IPE), based on problem-based learning (PBL) case scenarios. To define the optimal number of geriatric IPE sessions, the size and the ratio of participants from each profession in the learner groups, the outcomes related to the Kirkpatrick four-level typology of learning evaluation, students’ concerns about joint learning and impact of geriatric IPE on these concerns. The study looked at the perception of roles and expertise of the ‘other’ profession in interprofessional teams, and students’ choice of topics for future sessions. Students’ expectations, experience, learning points and the influence on the understanding of IP collaboration, as well as their readiness to participate in such education again were investigated.DesignA controlled before–after study (2014/2015, 2015/2016) with data collected immediately before and after the intervention period. Study includes additional comparison of the results from the intervention with a control group of students. Outcomes were determined with a validated ‘Readiness for Interprofessional Learning’ questionnaire, to which we added questions with free comments, combining quantitative and qualitative research methods. The teaching sessions were facilitated by experienced practitioners/educators, so each group had both, a clinician (either geratology consultant or registrar) and a senior nurse.Participants300 medical, 150 nursing students.SettingTertiary care university teaching hospital.ResultsAnalysis of the returned forms in the intervention group had shown that nursing students scored higher on teamwork and collaboration post-IPE (M=40.78, SD=4.05) than pre-IPE (M=34.59, SD=10.36)—statistically significant. On negative professional identity, they scored lower post-IPE (M=7.21, SD=4.2) than pre-IPE (M=8.46, SD=4.1)—statistically significant. The higher score on positive professional identity post-IPE (M=16.43, SD=2.76) than pre-IPE (M=14.32, SD=4.59) was also statistically significant. Likewise, the lower score on roles and responsibilities post-IPE (M=5.41, SD=1.63) than pre-IPE (M=6.84, SD=2.75).Medical students scored higher on teamwork and collaboration post-IPE (M=36.66, SD=5.1) than pre-IPE (M=32.68, SD=7.4)—statistically significant. Higher positive professional identity post-IPE (M=14.3, SD=3.2) than pre-IPE (M=13.1, SD=4.31)—statistically significant. The lower negative professional identity post-IPE (M=7.6, SD=3.17) than pre-IPE (M=8.36, SD=2.91) was not statistically significant. Nor was the post-IPE difference over roles and responsibilities (M=7.4, SD=1.85), pre-IPE (M=7.85, SD=2.1).In the control group, medical students scored higher for teamwork and collaboration post-IPE (M=36.07, SD=3.8) than pre-IPE (M=33.95, SD=3.37)—statistically significant, same for positive professional identity post-IPE (M=13.74, SD=2.64), pre-IPE (M=12.8, SD=2.29), while negative professional identity post-IPE (M=8.48, SD=2.52), pre-IPE (M=9, SD=2.07), and roles and responsibilities post-IPE (M=7.89, SD=1.69), pre-IPE (M=7.91, SD=1.51) shown no statistically significant differences. Student concerns, enhanced understanding of collaboration and readiness for future joint work were addressed, but not understanding of roles.ConclusionsEducators with nursing and medical backgrounds delivered geriatric IPE through case-based PBL. The optimal learner group size was determined. The equal numbers of participants from each profession for successful IPE are not necessary. The IPE delivered by clinicians and senior nurses had an overall positive impact on all participants, but more markedly on nursing students. Surprisingly, it had the same impact on medical students regardless if it was delivered to the mixed groups with nursing students, or to medical students alone. Teaching successfully addressed students’ concerns about joint learning and communication and ethics were most commonly suggested topics for the future.

scholarly journals Effects of a single interprofessional simulation session on medical and nursing students’ attitudes toward interprofessional learning and professional identity: A questionnaire study

2020 ◽  
Author(s):  
Bryan Burford ◽  
Paul Greig ◽  
Michael Kelleher ◽  
Clair Merriman ◽  
Alan Platt ◽  
...  
Keyword(s):  
Medical Students ◽  
Nursing Students ◽  
Professional Identity ◽  
Interprofessional Education ◽  
Group Membership ◽  
Professional Group ◽  
Student Group ◽  
Interprofessional Learning ◽  
Simulation Session ◽  
Students Attitudes

Abstract Background Participation in simulation-based interprofessional education (sim-IPE) may affect students’ attitudes towards interprofessional learning (through gaining experience with others) and their professional identity (by increasing the ‘fit’ of group membership). We examined this in two questionnaire studies involving students from four universities in two areas of the UK. Method Questionnaire data were collected before and after students took part in a sim-IPE session consisting of three acute scenarios. Questionnaires included the Readiness for Interprofessional Learning Scale (RIPLS) and measures of professional identity derived from the social identity theory literature. In Study 1, only identification with Professional Group (doctor or nurse) was measured, while in Study 2 identification with Student Group (medical or nursing student) and the immediate interprofessional Team worked with in the simulation were also measured. Linear mixed effects regression analysis examined the effect of the simulation session, and differences between medical and nursing students, sites and identity measures. Results A total of 194 medical and 266 nursing students completed questionnaires. A five-item subset of RIPLS (RIPLSCore) was used in analysis. In both studies RIPLSCore increased for all groups following participation in sim-IPE, although this was larger for nursing students in Study 1. Nursing students had consistently higher RIPLSCore scores than medical students at one site. Effects of the session on identity varied between sites, and dimensions of identity. Notably, while positive emotions associated with group membership (Ingroup Affect) increased for Student Group, Professional Group and Team, the sense of belonging (Ingroup Ties) and importance (Centrality) of the group increased only for Team. Nursing students had consistently higher identification scores than medical students. Conclusions Participation in a sim-IPE session can improve attitudes towards interprofessional learning. It can also enhance professional identity, particularly as related to emotional aspects of group membership, with possible benefits for wellbeing. Changes in identification with the immediate Team suggest positive psychological consequences of ad hoc Team formation in the workplace. Differences between medical and nursing students suggest their differing opportunities to work with other professions during training may change baseline attitudes and identity. However, a single sim-IPE session can still have an additive effect

scholarly journals Effectiveness of simulation-based interprofessional education for medical and nursing students in South Korea: a pre-post survey

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jihye Yu ◽  
woosuck Lee ◽  
Miran Kim ◽  
Sangcheon Choi ◽  
Sungeun Lee ◽  
...  
Keyword(s):  
Medical Students ◽  
Nursing Students ◽  
Interprofessional Education ◽  
Continuous Exposure ◽  
Interprofessional Practice ◽  
Interprofessional Learning ◽  
Simulation Based ◽  
Before And After ◽  
Effective Collaboration

Abstract Background Effective collaboration and communication among health care team members are critical for providing safe medical care. Interprofessional education aims to instruct healthcare students how to learn with, from, and about healthcare professionals from different occupations to encourage effective collaboration to provide safe and high-quality patient care. The purpose of this study is to confirm the effectiveness of Interprofessional education by comparing students’ attitudes toward interprofessional learning before and after simulation-based interprofessional education, the perception of teamwork and collaboration between physicians and nurses, and the self-reported competency differences among students in interprofessional practice. Methods The survey responses from 37 5th-year medical students and 38 4th-year nursing students who participated in an interprofessional education program were analyzed. The Attitude Towards Teamwork in Training Undergoing Designed Educational Simulation scale, the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration, and the Interprofessional Education Collaborative competency scale were used for this study. The demographic distribution of the study participants was obtained, and the perception differences before and after participation in interprofessional education between medical and nursing students were analyzed. Results After interprofessional education, student awareness of interprofessional learning and self-competency in interprofessional practice improved. Total scores for the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration did not change significantly among medical students but increased significantly among nursing students. Additionally, there was no significant change in the perception of the role of other professions among either medical or nursing students. Conclusions We observed an effect of interprofessional education on cultivating self-confidence and recognizing the importance of interprofessional collaboration between medical professions. It can be inferred that exposure to collaboration situations through Interprofessional education leads to a positive perception of interprofessional learning. However, even after their interprofessional education experience, existing perceptions of the role of other professional groups in the collaboration situation did not change, which shows the limitations of a one-time short-term program. This suggests that efforts should be made to ensure continuous exposure to social interaction experiences with other professions.

scholarly journals Effects of a single interprofessional simulation session on medical and nursing students’ attitudes toward interprofessional learning and professional identity: A questionnaire study

2019 ◽  
Author(s):  
Bryan Burford ◽  
Paul Greig ◽  
Michael Kelleher ◽  
Clair Merriman ◽  
Alan Platt ◽  
...  
Keyword(s):  
Medical Students ◽  
Nursing Students ◽  
Professional Identity ◽  
Interprofessional Education ◽  
Group Membership ◽  
Professional Group ◽  
Student Group ◽  
Interprofessional Learning ◽  
Simulation Session ◽  
Students Attitudes

Abstract BackgroundParticipation in simulation-based interprofessional education (sim-IPE) may affect students’ attitudes towards interprofessional learning (through gaining experience with others) and their professional identity (by increasing the ‘fit’ of group membership by performing a role). We examined this in two questionnaire studies involving two sites, with students drawn from four universities. MethodQuestionnaire data were collected before and after students took part in a sim-IPE session consisting of three acute scenarios.Questionnaires included the Readiness for Interprofessional Learning Scale (RIPLS) and measures of professional identity derived from the social identity theory literature. In Study 1 only identification with professional group was measured, while in Study 2 identification with Student group and the immediate interprofessional team were also measured.Linear mixed effects regression analysis examined the effect of the simulation session, and differences between medical and nursing students, between sites and between measures of Professional, Student and Team identity.Results194 medical and 266 nursing students completed questionnaires across the two studies.In both studies RIPLS increased for all groups following participation in sim-IPE, although this was larger for nursing students in Study 1. Nursing students had consistently higher RIPLS scores than medical students at one site.Effects of the simulation session on identity measures varied between sites and different dimensions of identity. Notably, while positive emotions associated with group membership increased for Student group, Professional group and Team, the sense of belonging (Ingroup Ties) and centrality of the group increased only for Team. There were also differences between sites. Nursing students had consistently higher identification scores than medical students.ConclusionsParticipation in a single sim-IPE can improve attitudes towards interprofessional learning. It can also enhance aspects of professional identity, particularly those related to affect, with potential benefits for wellbeing. Changes in identification with an immediate Team may suggest positive psychological consequences of ad hoc Team formation in the workplace.Differences between medical and nursing students suggest that their differing opportunities to work with other professions during training may change baseline attitudes and identity, but a single sim-IPE session can still have an additive effect.

scholarly journals A mixed methods study on the readiness of dental, medical, and nursing students for interprofessional learning

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0255086
Author(s):  
Mitsuyuki Numasawa ◽  
Nobutoshi Nawa ◽  
Yu Funakoshi ◽  
Kanako Noritake ◽  
Jun Tsuruta ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Nursing Students ◽  
Interprofessional Education ◽  
Japanese Version ◽  
Dental Students ◽  
Evidence Based ◽  
Interprofessional Learning ◽  
Before And After ◽  
Explanatory Sequential Design ◽  
Tokyo Medical

Background Interprofessional education (IPE) is crucial in dentistry, medicine, and nursing. However, scant mixed methods studies have compared the IPE outcomes across these disciplines to develop evidence-based IPE. This study explored the differences in the readiness of dental, medical, and nursing students for interprofessional learning before and after IPE workshops and elucidated reasons for this disparity. Methods Data were obtained from dental, medical, and nursing students who participated in IPE workshops conducted at Tokyo Medical and Dental University in Japan in 2019 and 2020. The participants filled the validated Japanese version of the Readiness for Interprofessional Learning Scale (RIPLS) before and after attending the workshops (n = 378). Paired t-tests were performed to assess differences between the pre- and post- workshop RIPLS scores. Welch’s t-tests were deployed to evaluate interdisciplinary differences in their scores. Qualitative analyses were conducted using an explanatory sequential design with focus group discussions (FGDs) held with 17 dental students to explain the quantitative results. Results Total RIPLS scores increased significantly for every discipline after the workshops (p < 0.001). Dental students scored significantly lower pre- and post- workshop aggregates than medical and nursing students, respectively (p < 0.001). The FGDs yielded three principal themes in the explanations tendered by dental students on their lower scores: 1) dental students rarely felt the need for interprofessional collaborations, 2) dentists often worked without the need for interprofessional collaborations, and 3) dental students believed their contribution to the workshop was insufficient. Conclusions The results revealed divergences in the readiness of dental, medical, and nursing students for interprofessional learning, and the study illuminated possible reasons for these disparities. These outcomes will help develop evidence-based IPE by indicating approaches to place a higher value on interprofessional collaborations in educational environments, ameliorate the awareness of educators, and enhance the workshop facilitation style.

scholarly journals Medical students’ readiness and perceptions about Interprofessional Education: A cross sectional study

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Hana Zamil ◽  
Sultan Ayoub Meo
Keyword(s):  
Medical Students ◽  
Professional Identity ◽  
Interprofessional Education ◽  
Positive Impact ◽  
Medical Schools ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Roles And Responsibilities ◽  
Clinical Scenarios

Objectives: Interprofessional Education (IPE) provides an environment where learners demonstrate the knowledge, skills and attitude required to manage the complex clinical scenarios in a collaborative and interprofessional manner. The actual sphere of influence of Interprofessional Education in many medical schools has been limited. Therefore, the present study aim was to evaluate the medical students’ readiness and perception of Interprofessional Education in a medical college in Saudi Arabia. Methods: This questionnaire based cross sectional study was executed in the Department of Physiology, College of Medicine, King Saud University during the period September 2016 to December 2017, using the 19-item Readiness for Interprofessional Learning Scale (RIPLS) with four subscales teamwork and collaboration, negative professional identity, positive professional identity and roles and responsibilities. The questionnaire was e-mailed to 1411 medical students and responses were analyzed using 5-point Likert scale. Results: A total of 158 medical students and trainees responded to the survey, 69 (43.6%) were males and 89 (56.4%) were females. The majority of participants 122-148 (77-94%) acknowledged the positive impact of IPE on teamwork and collaboration, more than two thirds 105 (64.45%) disagreed with negative attitude and 110-126 (70-80%) showed positive professional identity. Conclusions: Medical students showed a positive perception and ready to adopt the Interprofessional Educational allied activities in medical schools. The shared academic events would improve in clarifying the roles and responsibilities of medical students in health care professions. doi: https://doi.org/10.12669/pjms.36.4.2214 How to cite this:Alzamil H, Meo SA. Medical students’ readiness and perceptions about Interprofessional Education: A cross sectional study. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.2214 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Health profession readiness for interprofessional education in the Central Appalachia: a cross-sectional study

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 553
Author(s):  
Amanda Blankenship ◽  
George Asimellis ◽  
Bhargavi Joshi ◽  
Briana Rodriguez ◽  
Margaret Wright Sidle
Keyword(s):  
Medical Students ◽  
Nursing Students ◽  
Interprofessional Education ◽  
Student Attitudes ◽  
Clinical Problem ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Interprofessional Learning ◽  
Health And Social Care ◽  
Optometry Students

Background: This study on interprofessional relationships took place in Eastern Kentucky analyzing optometry, medical and nursing students at the University of Pikeville.  The Readiness for Interprofessional Learning Scale (RIPLS), regarding all three healthcare professional schools, was used to measure and determine students' views on working with one another.  The purpose of the study was to examine similarities and differences in student attitudes across the three health professional programs within the same university. Methods: Second year University of Pikeville (UPIKE) nursing, optometry, and medical students were given survey questions that followed the validated 19-item Readiness for Interprofessional Learning Scale (RIPLS). Results: While the optometry and medical students demonstrated statistically similar attitudes, key statistical findings included that nursing students were more likely than medical students to believe that clinical problem solving can only be learned effectively with students/professionals from their own school/organization (p = 0.015);  nursing students were more likely than medical students to welcome the opportunity to work on small group projects with other health and social care students/professionals (p = 0.018); and nursing students were more likely than both optometry and medical students to not be sure what their professional role will be/is  (p=.005). Conclusions: At the UPIKE, there is an observable difference between the attitudes toward IPE. Nursing students appeared to have a more positive attitude toward IPE than medical and optometry students, with the medical and optometry students having similar attitudes.

scholarly journals Differences between Perceived Readiness for Interprofessional Learning in Nursing and Other Health-related Students

2019 ◽  
Vol 25 (3) ◽  
pp. 312-320 ◽  
Author(s):  
Hyeonkyeong Lee ◽  
In Sook Kim ◽  
Tae Wha Lee ◽  
Gwang Suk Kim ◽  
Eunhee Cho ◽  
...  
Keyword(s):  
Nursing Education ◽  
Nursing Students ◽  
Interprofessional Education ◽  
Nursing Educators ◽  
Web Based ◽  
Undergraduate Nursing Students ◽  
Interprofessional Learning ◽  
Roles And Responsibilities ◽  
Undergraduate Nursing ◽  
Health Related

Purpose: The purpose of this study was to investigate the level of perceived readiness for interprofessional learning and its differences between nursing and other health-related students. Methods: A web-based survey was conducted from April 25 to June 30, 2017 in one university in Korea. A total of 325 undergraduate nursing students and other health-related disciplines completed the structured questionnaire consisting of Readiness for Interprofessional Learning Scale and general characteristics. Data were analyzed by descriptive statistics, t-test, ANOVA, and multiple linear regression. Results: The scores of readiness for interprofessional learning in nursing students were significantly higher than those in other health-related students (t=3.50, p=.001). Nursing students had higher collaboration, professional identity, and roles and responsibilities than other health-related students. The class experiences with other major students was a significant factor related to the readiness for interprofessional learning both in nursing (p=.001) and other health-related students (p=.001). Conclusion: The findings suggest that nursing educators consider the different level of readiness for interprofessional learning between nursing and other health-related students while integrating interprofessional education into nursing education curricula.

scholarly journals EFFECT OF INTERPROFESSIONAL EDUCATION MODEL TO TEAM WORK AND COLLABORATION ATTITUDES OF NURSING STUDENTS IN THE INTENSIVE CARE UNIT OF HOSPITAL

2017 ◽  
Vol 1 (2) ◽  
pp. 115
Author(s):  
Eny Kusmiran ◽  
Istianah Istianah ◽  
Lisbet Octovia Manalu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nursing Students ◽  
Interprofessional Education ◽  
Intervention Group ◽  
Team Work ◽  
Control Group ◽  
Before And After ◽  
Quasi Experimental ◽  
The Difference

Background: International policy recommends Interprofesional Education (IPE) to improve the practice of interprofessional In an effort to improve the practice of professional nurses, the IPE is the strategy of forming professional conduct of nurses in team work and collaboration between other health professionals, especially doctors in critical care. Objective: to identify the effect of IPE model of team work and collaboration of the attitudes of nursing students in an intensive care unit of Hospital. Methods: This study was conducted with The quasi-experimental design. The number of 30 subjects (15 intervention and 15 control group) by random sampling. The intervention consisted of 1) pretest 2) the provision of material interprofessional education modules on subjects of critical nursing for 2 weeks, 2) posttest. Paired t tests were used to determine the effects of interprofessional Education. Independence t-test were used to determine the difference effect of interprofessional Education. The instrument used was The Attitudes towards interprofessional Health Care Teams Scales to measure the attitude of teamwork and Interprofesional Collaboration Scales to measure the attitude of collaboration. Results: There were differences rates of team work and collaboration attitudes of nurses before and after on intervention group. There werenot differences rates of team work and collaboration attitudes of nurses before and after on control group. There were differences scores of the attitude of team work and collaboration between the intervention and control groups. Conclusions and Recommendations: Giving IPE modules for nurses are commonly regarded to be an essential strategy for improving team work and collaboration attitudes on nurses student at intensive care unit of hospital. Keyword: Interprofessional Education, team work, collaboration, nurses student.

scholarly journals Stress of nursing students in clinical simulation: a randomized clinical trial

2018 ◽  
Vol 71 (3) ◽  
pp. 967-974 ◽  
Author(s):  
Radamés Boostel ◽  
Jorge Vinícius Cestari Felix ◽  
Carina Bortolato-Major ◽  
Edivane Pedrolo ◽  
Stela Adami Vayego ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Nursing Students ◽  
Randomized Clinical Trial ◽  
Interpersonal Relationships ◽  
Control Group ◽  
High Fidelity ◽  
Clinical Simulation ◽  
Skill Laboratory ◽  
Before And After ◽  
Experimental Group

ABSTRACT Objective: To evaluate and compare the perception of stressors by nursing students before and after a high-fidelity clinical simulation or conventional laboratory practice class. Method: This is a randomized clinical trial conducted with 52 nursing students. Both groups had theoretical classes about cardiothoracic physical examination, followed by practice class in skill laboratory. In addition, the experimental group took part in a high-fidelity simulation scenario. Stressors were evaluated before and after class, with the application of KEZKAK questionnaire. Results: The experimental group was significantly more worried about six factors related to lack of competence and to interpersonal relationships (p < 0.05), while the control group was significantly more worried about being in contact with suffering (p = 0.0315). Conclusion: The simulation affects students’ perception of stressors and promotes their self-evaluation and critical thinking regarding the responsibility that comes with their learning.

scholarly journals Possibilities for interprofessional learning at a Swedish acute healthcare ward not dedicated to interprofessional education: an ethnographic study

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e027590 ◽  
Author(s):  
Ann Hägg-Martinell ◽  
Håkan Hult ◽  
Peter Henriksson ◽  
Anna Kiessling
Keyword(s):  
Nursing Students ◽  
Interprofessional Education ◽  
Ethnographic Study ◽  
Clinical Settings ◽  
Interprofessional Learning ◽  
Staff Members ◽  
Questions And Answers ◽  
Field Notes ◽  
Almost All ◽  
Acute Healthcare

ObjectivesAlmost all healthcare today is team-based in collaboration over professional borders, and numerous students have work-based learning in such contexts. However, interprofessional learning (IPL) in clinical settings has mostly been systematically explored in specially designed contexts dedicated to interprofessional education (IPE). This study aimed to explore the possibilities for IPL activities, and if or how they occur, in an acute ward context not dedicated to IPE.Design and settingBetween 2011 and 2013 ethnographic observations were performed of medical and nursing students’ interactions and IPL during early clerkship at an acute internal medicine ward in Sweden. Field notes were taken and analysed based on the framework of IPE:learning with, from and about.Participants21 medical, 4 nursing students and 30 supervisors participated.ResultsLearning with—there were no organised IPE activities. Instead, medical and nursing students learnt in parallel. However, students interacted with staff members from other professions.Learning from—interprofessional supervision was frequent. Interprofessional supervision of nursing students by doctors focused on theoretical questions and answers, while interprofessional supervision of medical students by nurses focused on the performance of technical skills.Learning about—students were observed to actively observe interactions between staff and learnt how staff conducted different tasks.ConclusionThis study shows that there were plenty of possibilities for IPL activities, but the potential was not fully utilised or facilitated. Serendipitous IPL activities differed between observed medical and nursing students. Although interprofessional supervision was fairly frequent, students were not learning with, from or about each other over professional borders.

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