Collaborative practice competencies needed for telehealth delivery by health and social care professionals: a scoping review

ABSTRACT

In the context of the COVID-19 pandemic, many healthcare and social services professionals have had to provide services through virtual care. In the workplace, such professionals often need to be sufficiently resourced to collaborate and address collaborative care barriers in telehealth. We performed a scoping review to identify the competencies required to support interprofessional collaboration among clinicians in telehealth. We followed Arksey and O’Malley’s and the Joanna Briggs Institute’s methodological guidelines, including quantitative and qualitative peer-reviewed articles published between 2010 and 2021. We expanded our data sources by searching for any organization or experts in the field via Google. The analysis of the resulting thirty-one studies and sixteen documents highlighted that health and social services professionals are generally unaware of the competencies they need to develop or maintain interprofessional collaboration in telehealth. In an era of digital innovations, we believe this gap may jeopardize the quality of the services offered to patients and needs to be addressed. Of the six competency domains in the National Interprofessional Competency Framework, it was observed that interprofessional conflict resolution was the competency that emerged least as an essential competency to be developed, while interprofessional communication and patient/client/family/community-centered care were identified as the two most reported essential competencies.

KEYWORDS:

• Competencies
• health and social services professionals
• interprofessional teams
• telehealth

Introduction

Interprofessional collaboration has been defined as “a practice that emerges when several health and social services professionals from different professional backgrounds collaborate with patients, families, caregivers and the community, to provide the highest possible quality of care in different settings” (Glardon, 2018). Collaboration involves developing and maintaining effective relationships between clinicians, patients, families, and communities to reach optimal health outcomes (Orchard et al., 2010). It is one of many innovative practices that must be implemented to avoid problems with continuity of care (Orchard et al., 2010). The World Health Organization (WHO) (Hopkins, 2010) reports that interprofessional collaboration increases the quality of care, patient safety, and patient satisfaction with care. The benefits of interprofessional collaboration also include increased job satisfaction and motivation among professionals (Glardon, 2018), practice quality (Couturier & Belzile, 2018; Johnson & Mahan, 2019), patient engagement in care, and as a result, a more positive experience of care and, therefore, of their health (Fortin et al., 2021). Finally, interprofessional collaboration leads to improved clinical practice and optimization of patient care (Reeves et al., 2017).

It is well documented that professionals must develop specific competencies to establish adequate face-to-face interprofessional collaboration (Orchard et al., 2010). These competencies are the complex integration of knowledge, skills, attitudes, values, and judgments that allow a health provider to apply these components to all collaborative situations. Competencies should guide growth and development throughout life and enable one to effectively perform the activities required in a given occupation or function and various contexts (Orchard et al., 2010). The national interprofessional competency framework (Orchard et al., 2010) used an integrative approach to group competencies into six domains that allow students and practitioners to increase their interprofessional collaboration practices no matter their level of skills or their type of practice setting. These six domains are: 1) interprofessional communication 2) patient/client/family/community-centered care 3) role clarification 4) team functioning 5) collaborative leadership 6) interprofessional conflict resolution. Each domain contains several competencies to enhance collaborative practice. For example, in team functioning, the framework proposes that practitioners understand the process of team development, participate, be respectful of all members’ participation in collaborative decision-making, and respect team ethics, including confidentiality, resource allocation, and professionalism (Orchard et al., 2010). Although the literature is abundant on competencies for interprofessional collaboration, it is mainly limited to face-to-face activities (Carney et al., 2019; Sangaleti et al., 2017; Thye et al., 2018).

Background

Given the adoption of technological advances in healthcare in the context of the COVID-19 pandemic (Ministère de la santé et des services sociaux, 2020), the dissemination of telehealth practices has dramatically increased between 2020 and 2021 (Jnr, 2020; Lemire & Mang, 2020; M. S. Jones et al., 2020; Ministère de la santé et des services sociaux, 2020; Opatrny & Forgues, 2020). Telehealth is defined here as any interaction between a patient and a health care professional that occurs remotely and uses some form of information technology (e.g., virtual approaches through video conferencing, Zoom, Teams, and Reacts) or communication (e.g., telephone, e-mail, SMS) (Lemire & Mang, 2020) In combination with face-to-face care, professionals increasingly provide telehealth care through remote interactions with patients and other professionals using new information or communication technologies that were not designed for this purpose (Lemire & Mang, 2020).

Despite its potential, telehealth has been subject to critique. Some organizations recommend that all patients be offered the possibility of requesting and obtaining a face-to-face consultation to avoid adverse effects such as inappropriate referrals to emergency departments (Collège des médecins du Québec, 2020). Adverse impact on interprofessional collaboration can also be anticipated (e.g., fewer interprofessional discussions and fewer referrals to other professionals) (Breton & Hudon, 2020; Hafner et al., 2021; Schwamm et al., 2020). Despite these criticisms, telehealth care is expected to remain commonplace after the pandemic (Poitras et al., 2022) but with more precise guidelines for use. A recent study of 603 primary care respondents estimated that between 90% and 100% of professionals will still use telehealth after the pandemic, and 28% expect to use it more than 50% of the time (Breton et al., 2021).

Currently, there needs to be more awareness of the competencies considered essential for interprofessional collaboration in telehealth settings (A. Wong et al., 2021). This lack of knowledge may impede the development of adequate support for health and social services professionals to implement effective collaborative practices, even in telehealth settings (A. Wong et al., 2021; Stamenova et al., 2020).

To address this knowledge gap, we conducted a scoping review with the following objectives:

1. To describe telehealth interventions in the context of interprofessional collaboration

2. To identify competencies that facilitate interprofessional collaboration in telehealth (based on the competencies established by the national interprofessional competency framework)

3. To formulate recommendations to support the adjustment of initial and continuing education to the context of collaborative telehealth care

Method

This review was conducted following the methodological framework for scoping review studies proposed by the Joanna Briggs Institute (Peters, Godfrey, et al., 2015), which is based on previous work by (Peters, Godfrey, et al., 2015) and, Arksey and O’Malley (Arksey & O’Malley, 2005). This method, which includes a role for key stakeholders and proposes an iterative reflection process, is the most appropriate to examine the literature comprehensively. Our scoping review protocol was written using Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) (A. C. Tricco et al., 2017). We reported our results using the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping review (PRISMA-ScR) (A. Tricco et al., 2018).

The research question

This scoping review was guided by the question:

What are collaborative practice competencies needed for telehealth delivery by health and social care professionals?

Data sources and search strategy

To identify relevant studies published between January 2010 and February 2021, we searched the following databases: MEDLINE, CINAHL, Social work abstracts, APA PsycArticles, APA PsycInfo, APA PsycExtra, Psychology, and Behavioral Sciences Collection, and SociINDEX. The search strategy included keywords (Supplementary File 1) associated with the following concepts: 1) telehealth; 2) health and social services professionals; 3) competency; 4) interprofessional collaboration. Results were imported into Endnote X9 to be classified and to eliminate duplicates.

To identify any relevant studies available through the gray literature, a second literature search was conducted with Google search. The investigation was performed using the exact keywords used in the literature search of scientific articles. For each internet search result, we reviewed the first five pages by reading the titles and clicking on each link to validate the relevance of each website. By limiting ourselves in this way, we ensured that the most relevant articles would be captured and that the search would aggregate a manageable number of documents (Godin et al., 2015). Studies were included if they were:

1. published in English or French

2. published between January 2010 and February 2021

3. any scientific article, documents from organizations or government or website that contributed to answering the research question

Studies were excluded if the document was not accessible digitally or through inter-institutional sharing.

Sources of evidence selection and calibration exercise

Before the study selection process, two reviewers (PB and AG) conducted a pilot selection of the first ten articles to ensure they understood the eligibility criteria similarly (Peters, Godfrey, et al., 2015). This calibration was supervised by two verifiers (MEP and VTV) who validated the selection. After this pilot selection, a satisfactory interrater agreement was reached between the two reviewers (PB and AG) and two verifiers (MEP and VTV). Next, both reviewers independently reviewed the titles and abstracts to select the articles. When in doubt, a reading of the complete article was performed. A third person (MEP), a verifier, was involved in case of discrepancies. The reviewers (PB and AG) then read all the articles and excluded those not meeting the inclusion criteria. One reviewer (PB) was also in charge of including and reviewing the papers from the gray literature. The verifiers (MEP and VTV) also validated this selection. The agreement rate for studies and documents from the gray literature at this stage was 100%. According to Joanna Briggs Institutes’ guidelines, quality appraisal and risk of bias assessment is not applicable for scoping review (Peters, Sousa, et al., 2015).

Charting the data

Data were extracted into an electronic form driven and informed by the Cochrane taxonomy adapted from EPOC (Effective Practice and Organization of Care) (2015). The form was jointly developed by the first reviewer (PB) and two verifiers (MEP and VTV) and included the following items:

• general characteristics (e.g., authors, year of publication, country, language);

• study characteristics (e.g., study design, objectives, conceptual framework, population);

• characteristics of the clinical settings evaluated (e.g., number of collaborating clinics, type of clinic);

• publication characteristics related to:

  1. tools used for telehealth;

  2. collaborative practices in telehealth settings;

  3. definition of collaboration;

  4. competencies needed for collaborative practices in telehealth and elements that facilitate or impede their development;

  5. facilitators and barriers to interprofessional collaboration in telehealth;

The first reviewer (PB) conducted a comprehensive reading of the articles and gray literature and extracted the data into the form. A second reviewer (CC, AB, or AM) co-extracted the data. Meetings were held with the first reviewer (PB) and first verifier (MEP) to compare and adjust the data extracted from each article.

Consulting with relevant stakeholders

The research team includes key stakeholders (LF, JR, JM) from the health and social services involved in telehealth use in a clinical context. They were actively involved in this study, and their contribution ensured that the recommendations were consistent with what was happening in the field. To discuss themes addressed in the scoping review and the results, two meetings were held between the members of the research team and the stakeholders collaborating on the project. Consultation with the stakeholders allowed us to validate coherence between the results of the scoping review and what is happening in a clinical context. These meetings also allowed us to identify the determinants of interprofessional collaboration in the telehealth context from the data that emerged from the analysis. These determinants were judged essential to the work currently done by our team and were added as results of the scoping review.

Data analysis and synthesis

Both inductive and deductive approaches were used to code qualitative data. First, we performed a deductive thematic analysis using National Interprofessional Competency Framework (Orchard et al., 2010). This framework is composed of six dimensions: 1) interprofessional communication; 2) patient/client/family/community-centered care; 3) team functioning; 4) role clarification; 5) collaborative leadership; and 6) interprofessional conflict resolution (Orchard et al., 2010). Then, we performed an inductive thematic analysis to identify emerging themes about the determinants of collaboration practice (Hopkins, 2010; Orchard et al., 2010).

An Excel spreadsheet was created by the first reviewer (PB) and three verifiers (MEP, VTV, YC) to extract the information relevant to our study topic. Data were synthesized iteratively by these authors to answer the search question: What collaborative practice competencies are needed for telehealth delivery by health and social care professionals?

Once all the data had been extracted by the four reviewers (PB, CC, AB, AM), an annotated document grouping the critical information by themes was created by the first reviewer (PB) and presented to three verifiers (MEP, VTV, YC). This validation step provided an opportunity to review preliminary results and discuss themes to be included to answer the research question. As Joanna Briggs Institute methodology recommends, a subsequent circle of discussion was also conducted with all co-investigators and stakeholders to present the final list of themes and main findings generated by our data analysis and synthesis.

Results

The search strategy identified 380 articles and 72 websites. Following the screening process (Table 1), 31 articles and 17 websites, and government documents that met the inclusion criteria were selected. To illustrate the search and selection process during the scoping review, we used the PRISMA-ScR diagram shown in Figure 1. Of the included articles and documents, 55% were published after 2016, as shown in Figure 2. Most studies (72%) were from the United States or Canada (Figure 2). All articles were published in English, and 81% of government documents and websites were in English. Finally, 45% of the articles focused on interprofessional telehealth competencies, while 55% focused on evaluating or implementing a telehealth intervention.

Figure 1. Number of documents including compentencies from the National Interprofessional Competency Framework.

Table 1. Description of included studies.

Author (s)	Country	Study design	Population	Description of collaboration	Collaborative competencies
Allen, Aylott (2015)	Canada	Theorical article	Nurses, different specialists	Remote specialists and senior nurses collaborated with nurses in real-time to conduct assessments or help for technical task	Interprofessional communication Patient-centered care Team functioning
Avey and Hobbs (Crumley et al., 2018)	United States	Qualitative design	Direct staff working with clients, administrative staff and IT professionals	Referrals between healthcare providers	Interprofessional communication Patient-centered care Team functioning
Barakat, Woolrych (L’Esperance & Perry, 2016)	Netherlands	Workshop	Staff and IT professionals	The workshop consisted of two days of presentations and collaborative discussions to clarify the role of healthcare professionals in the application, development, and integration of eHealth technologies to support older adults to age in place.	Interprofessional communication
Barbosa and Silva (Galpin et al., 2020)	Brazil	Qualitative design	Doctors and nurses	Doctors and nurses working in telehealth.	Interprofessional communication Team functioning
Brandt, Søgaard (Barbosa & Silva, 2017)	Denmark	Qualitative design	Clinical dieticians, physiotherapists, nurses, nurse assistants, occupational therapists	Hybrid eHealth lifestyle coaching using a combination of synchronous face-to-face meetings and asynchronous eHealth coaching through a collaborative eHealth tool	Patient engagement
Brunacini (Filipova, 2015)	United States	Quality improvement study	International satellite clinicians from many health disciplines	There were international satellite clinicians from many health disciplines within the entire organization, spanning medicine, dietetics, health psychology, exercise science, and pharmacy, who worked together virtually for collaborations, consultations, and referrals based on patient needs. Interventions to improve patient engagement included an initial intake form used by the team for new patient consultations	Interprofessional communication Patient-centered care Team functioning Patient engagement
Bruneau, Bier (Allen et al., 2015)	Canada	Mixed-method design	Nurses, social workers, general physicians, general psychiatrists, specialized educators	During teleconsultation, the IUGM team members first met with the patient, a family member, a member of the direct care team and the staff member (pivot) from the MIHC’s BPSD team who was responsible for the consultation. The geriatric psychiatrist and geriatric psychologist conducted a formal assessment during the consultation. Then the patient left and all members of the MIHC BPSD team joined in.	Interprofessional communication Patient-centered care Team functioning Collaborative leadership Interprofessional conflict resolution Patient engagement
Corriveau, Couturier (Vessey et al., 2015)	Canada	Mixed-method design	Community nurses, doctors or other health professionals	Healthcare managers implemented a new service delivery model including teleassistance. Teleassistance is defined as a clinical act performed by a doctor or a health professional intervening with a patient or his or her family under the assistance of an expert, via videoconference. In the current project, teleassistance was provided by virtual clinics.	Role clarification
Crumley, Blom (Nelson et al., 2011)	South Africa	Qualitative design	Physicians	“mHealth for Burn Diagnostics and Care in South Africa” is a telemedicine project, specifically developed to help improve outcomes for acute burns patients, through its deployment in trauma and emergency setting. Using smart phone technology, the project involved the development of an app which allows doctors in rural, resource poor areas, or secondary level emergency departments, to send images and textual descriptions of burn cases to an on-call tele-expert, who then replies via the app with management and referral advice.	Interprofessional communication Role clarification Collaborative leadership
Filipova (Peters, Sousa, et al., 2015)	United States	Cross-sectional design	Nurses and physicians	Telehealth can improve convenience for both patients and clinicians, while potentially reducing healthcare system costs. For example, a physician may provide consultation at an offsite location using audiovisual equipment to perform a clinical wound assessment or interpret an electrocardiogram.	Interprofessional communication
Fraser, Mackean (Barakat et al., 2013)	Australia	Systematic review	Healthcare professionals working with Indigenous people	Relationship development between Indigenous clients and healthcare professionals. Culturally competent healthcare professionals and health service delivery may facilitate culturally acceptable telehealth. For the non-Indigenous health professionals, working at the cultural interface requires critical questioning of professional assumptions.	Patient-centered care
Galpin, Sikka (Pappas et al., 2019)	United States	Delphi study	Any healthcare professionals	N/A	Interprofessional communication Patient-centered care
Gifford, Niles (World Health Organzation, 2018)	United States	Quasi-experimental design	Counselors, social workers, psychologists, physicians	Development and implementation of behavioral telehealth services with paraprofessionals health aides in rural villages of Alaska.	Role clarification
Goran (Avey & Hobbs, 2013)	United States	Descriptive study	Critical care nurses and intensivists	The tele-ICU nurse’s work tends to be focused on 4 areas: (1) virtual rounding, (2) alert recognition and response, (3) providing bedside team support, and (4) coaching and collaboration.	Interprofessional communication Role clarification Team functioning Interprofessional conflict resolution
Henry, Billingsly (Fraser et al., 2017)	United States	Multi-stage iterative approach	Practitioners (audiology, medicine, nursing), educators, administrators	N/A	Interprofessional communication Patient-centered care Role clarification
Hilty, Chan (D. M. Hilty et al., 2018)	United States	Scoping review	Any healthcare professionals working in behavioral health	In behavioral health, coordination and collaboration may involve different associations.	Interprofessional communication Team functioning
Hilty, Maheu (Lazzara et al., 2015)	United States	Literature review	Peer provider, social workers, primary care providers, pharmacists, psychologists, nurses, psychiatrists	Telepsychiatric and Telebehavioral Health Competencies	Interprofessional communication Patient-centered care
Kujala, Heponiemi (D. Hilty et al., 2020)	Finland	Mixed-method design	Nurses, social workers, physicians, supervisors, leaders	In this study, we examine the current state of eHealth competencies of clinical leaders in two public healthcare organizations	Interprofessional communication Patient-centered care
L’Esperance and Perry (Smith-Strøm et al., 2016)	United States	Mixed-method design	Healthcare providers who work in diabetes clinics	MyCareTeam, an online diabetes management system	Patient engagement
Lazzara, Benishek (R. Wong et al., 2020)	United States	Quasi-experimental design	Healthcare providers working in Trauma Intensive Care Unit (nurses, attending physicians, residents, fellows, nurse practitioners)	Healthcare providers conduct rounds (i.e., a formal, daily meeting comprising healthcare providers who discuss the status of the patient and evaluate the treatment plan) remotely (i.e., not in immediate proximity of the patient).	Interprofessional communication
Lewis and Wyatt (Henry et al., 2021)	United Kingdom	Literature review	Any healthcare providers	Clinicians, patients and others use mobile medical apps	Interprofessional communication Patient-centered care
Nelson, Bui (Bruneau et al., 2020)	United States	Descriptive study	Psychology graduate students, social work students, counseling students, psychiatry fellows, pediatrics residents, medical students, and others	We developed an interdisciplinary telemedicine clinic (TeleHelp clinic) to evaluate and treat youth depression. Real-time videoconferencing is used to bridge the gap between evidence-supported youth depression treatment and limited/no access to specialty mental health providers.	Interprofessional communication Collaborative leadership
Pappas, Vseteckova (Brunacini, 2019)	United Kingdom	Qualitative design	General practitioners, nurses, and consultants	In order to overcome the fact that the specialist cannot directly assess the patient’s symptoms, active collaboration is established between the professionals during physical examination through telemedicine.	Interprofessional communication Role clarification Team functioning Collaborative leadership
Shortridge, Steinheider (Brandt et al., 2018)	United States	Quasi-experimental design	Nurse practitioners, physical therapy and occupational therapy students	The distant participant connects to a telehealth cart or substitute equipment while the other students in each group interact directly with the standardized patient and use the telehealth cart equipment.	Interprofessional communication Patient-centered care Team functioning
Skiba, Barton (Goran, 2012)	United States	Experimental design (RCT)	Advanced practice nurses, physicians’ and pharmacists’ students	The overall goal of the iTEAM Project is to provide enhanced technology IP learning experiences through the use of simulations with standardized patients (physical and virtual), e-health (telehealth & mobile health) experiences, the integration of informatics and the use of Electronic Health Records (EHRs) within graduate education.	Interprofessional communication Patient-centered care Team functioning Role clarification
Slovensky, Malvey (Kujala et al., 2019)	United States	Theorical article	Healthcare providers (especially physicians and nurses)	Collaboration among members of an interprofessional team with diverse knowledge, experience, and skills is paramount to design, implementation, and evaluation of telehealth programming just as it is with any facet of healthcare delivery.	Interprofessional communication Patient-centered care Team functioning
Smith-Strøm, Iversen (Skiba et al., 2014)	Norway	Experimental design (RCT)	Home care nurses	The home care nurse would take a digital image of the patients’ ulcers and would send it to the expert wound care team at the outpatient clinic for assessment and feedback.	Interprofessional communication Patient-centered care Team functioning Collaborative leadership
Thye, Shaw (Thye et al., 2018)	Germany	Cross-sectional design	International experts: Academic or non-academic teaching and/or education, health data management, physician, clinical CEOs, nursing, technical CEOs, pharmacist, clinical CIOs Other health care professions (e.g. physiotherapy, technical CIOs Other healthcare institution worker or staff, science & research, engineering or IT specialist	As health IT supports processes along the entire patient trajectory it involves different types of professional groups that are interacting to achieve the patient outcomes targeted. Thus, in principle, eHealth is inter-professional by nature and must also be reflected in education and training, e.g., of physicians, nurses and other professionals working in direct patient care.	Interprofessional communication Collaborative leadership
van Houwelingen, Moerman (Lewis & Wyatt, 2014)	Netherlands	Delphi study	Nurses	N/A	Interprofessional communication Patient-centered care Collaborative leadership
Vessey, McCrave (Slovensky et al., 2017)	United States	Quality improvement	Clinical nurses, nurse scientists	Patient and family-initiated calls fall into two categories. The first are “hot lines” where patients and families seek advice and clinical guidance on common health concerns. The second is patient or family-initiated telephone encounters (PiTEs) where they are seeking advice for the management of complex chronic conditions. Individuals answering the calls may be either professional nurses or adjunct personnel with specific training in call management. Computer decision support systems (CDSS) have been developed to help nursing and non-nurse personnel provide clinical guidance	Patient-centered care Role clarification Team functioning
Wong, Ng (Shortridge et al., 2016)	United States	Mixed-method design	First and third-year internal medicine residents, social work, pain management, psychiatry/addiction medicine and nursing	A longitudinal simulation to teach interdisciplinary telemedicine and e-communication skills. It was a simulation of interdisciplinary collaboration in telehealth.	Interprofessional communication Team functioning

Figure 2. The number of documents referring to the competencies included in the National Interprofessional Competency Framework.

The articles reviewed reported the inclusion of multiple professionals on interprofessional teams. Most included nurses (85%) and physicians (55%). Other professionals included in the interprofessional teams were social workers (30%), mental health specialists (psychologists, psychiatrists) (25%), pharmacists (15%), physical therapists (15%), occupational therapists (10%), information and communications technology (ICT) professionals (10%), administrative staff (5%), nutritionists (5%) and special care counselors (5%).

Objective 1: Description of telehealth interventions in the context of interprofessional collaboration

Studies that addressed collaboration between professionals in telehealth settings can be categorized into two types of practices: 1) access to a specialist located at a remote site (n = 10) (Allen et al., 2015; Avey & Hobbs, 2013; Barbosa & Silva, 2017; Brunacini, 2019; Bruneau et al., 2020; Crumley et al., 2018; Filipova, 2015; Galpin et al., 2020; Nelson et al., 2011; Pappas et al., 2019) and 2) collaboration between professionals at the same level in terms of specialty for the follow-up of a patient using a mobile application or a telehealth device (n = 10) (Barakat et al., 2013; Brandt et al., 2018; D. M. Hilty et al., 2018; Goran, 2012; Lazzara et al., 2015; L’Esperance & Perry, 2016; R. Wong et al., 2020; Shortridge et al., 2016; Skiba et al., 2014; Smith-Strøm et al., 2016). Access to a specialist at a remote site involves real-time collaboration. For example, a geriatrician working remotely can guide a nurse in a clinic for cognitive assessments, strength testing, and physical assessments of elderly patients (Allen et al., 2015). Because elderly patients typically present with various mental and physical conditions, close communication between nurses in the clinic and the remote geriatrician appears essential to optimize patient care (Allen et al., 2015). In the weight loss management program presented by Brunacini et al. (Brunacini, 2019), international remote clinicians from many health disciplines, such as medicine, dietetics, health psychology, physical activity science, and pharmacy, work together virtually for collaborations, consultations, and referrals based on patients’ needs. The interventions performed by each team member are primarily aimed at improving patient engagement with their condition (Brunacini, 2019).

The included studies also explored collaboration between professionals to monitor patients through a mobile application or virtual care device. For example, Barakat et al. (Barakat et al., 2013) present the competencies needed to use e-health technology to enable aging individuals to remain at home for as long as possible, while L’Esperance et al. (L’Esperance & Perry, 2016) propose a diabetes management platform to facilitate collaboration between professionals as well as communication between the patient and professionals. Brandt et al. (Brandt et al., 2018) evaluated the success of virtual coaching using a collaborative eHealth tool on lifestyle change by an interprofessional team of nutritionists, physical therapists, nurses, and occupational therapists.

Several papers identified in this scoping review address the patient-healthcare professional relationship in telehealth settings, but only a few directly reference collaborative competencies.

For example, the study by Filipova et al. (Filipova, 2015) discusses one of the benefits of telehealth as improved interprofessional collaboration. Among other things, the authors describe that it is essential to increase the ability of clinicians to communicate and exchange data in an accurate, secure, and efficient manner. An easily interoperable system across various healthcare settings promotes better clinician communication and improves patient care quality, efficiency, and cost. Henry et al. (D. Hilty et al., 2020) explore the various interpersonal competencies to be developed to optimize virtual consultations. The authors mention that communication competencies are necessary for virtual care. Indeed, it is essential for shared decision-making and fostering a therapeutic alliance with the patient. Communication competencies also allow for the presentation and clarification of each care team member’s role in carrying out effective virtual encounters.

Objective 2: Professional competencies to facilitate interprofessional collaboration in telehealth

Among the six competency domains described by the National Interprofessional

Competency Framework, communicative competence is the most often cited (Allen et al., 2015; Association of American Medical College, 2022; Avey & Hobbs, 2013; Barakat et al., 2013; Barbosa & Silva, 2017; Brunacini, 2019; Bruneau et al., 2020; Canadian Patient Safety Institute, 2020; Crumley et al., 2018; D. Hilty et al., 2020; D. M. Hilty et al., 2018; Filipova, 2015; Galpin et al., 2020; Goran, 2012; Henry et al., 2021; Kujala et al., 2019; Lazzara et al., 2015; Lewis & Wyatt, 2014; Nelson et al., 2011; Pappas et al., 2019; R. Wong et al., 2020; Shortridge et al., 2016; Skiba et al., 2014; Slovensky et al., 2017; Smith-Strøm et al., 2016; Thye et al., 2018; van Houwelingen et al., 2016; Virtual Care Task Force, 2020) (see Figure 3). As Barakat (Barakat et al., 2013) reported, professionals must engage in regular communication to facilitate working together with other healthcare providers, despite eHealth technologies being implemented. These technologies are often implemented to enable information sharing between organizations, but this sharing should not be at the expense of verbal communication between professionals (Barakat et al., 2013). This probably also reflects that telehealth tools often focus on user communication support.

The second most often reported competency is the ability to provide patient/client/family/community-centered care, despite the distance created by telehealth (Allen et al., 2015; American Psychiatric Association, 2020; Avey & Hobbs, 2013; Brunacini, 2019; Bruneau et al., 2020; World Health Organization, 2018; D. M. Hilty et al., 2018; Fraser et al., 2017; Galpin et al., 2020; Kujala et al., 2019; Lewis & Wyatt, 2014; Shortridge et al., 2016; Skiba et al., 2014; Slovensky et al., 2017; Smith-Strøm et al., 2016; The College of Family Physicians of Canada, 2021; van Houwelingen et al., 2016; Vessey et al., 2015; Virtual Care Task Force, 2020). Related to this, Henry et al. (Henry et al., 2021) believe that the social presence theory provides a social context for computer-mediated communication or other telecommunication devices. According to this theory, presence has an essential psychosocial dimension, being at a distance could have cognitive implications for patient-centered care, particularly about verbal and nonverbal communication that may be different in telehealth settings (Henry et al., 2021). Finally, this theory suggests that developing a therapeutic relationship could be more challenging to establish in telehealth (Henry et al., 2021). According to Skiba et al. (Skiba et al., 2014), patient-centered care must remain at the core of the interprofessional collaborative practice, despite the virtual context in which it is carried out. For example, interprofessional education activities could promote communication using the electronic medical record, allowing professionals to identify tools to engage patients in their care (Skiba et al., 2014).

For several authors (Avey & Hobbs, 2013; Barakat et al., 2013; Bruneau et al., 2020; Crumley et al., 2018; D. Hilty et al., 2020; D. M. Hilty et al., 2018; Galpin et al., 2020; Goran, 2012; Kujala et al., 2019; Lazzara et al., 2015; L’Esperance & Perry, 2016; Nelson et al., 2011; Shortridge et al., 2016; Skiba et al., 2014; Slovensky et al., 2017; Smith-Strøm et al., 2016; van Houwelingen et al., 2016), technological competence is a vital competency specific to interprofessional collaboration in telehealth. This procedural competence is often partially present and sometimes even absent, thus requiring special attention. Hilty et al. (D. Hilty et al., 2020) report that the Institute of Medicine closely links interprofessional teamwork and information technology literacy. Skiba et al. (2015; Skiba et al., 2014) also highlight the importance of continuous quality improvement regarding communication technologies and teamwork processes. Finally, van Houwelingen et al. (van Houwelingen et al., 2016) argue that ongoing competency development is essential, especially in light of the rapid growth of new technologies. Thus, health professionals should have all the necessary competencies to integrate technologies into their practice to promote efficient exchanges between colleagues in telehealth (van Houwelingen et al., 2016).

Although not specific to telehealth, the ability to work in teams is still another critical competency to develop (Allen et al., 2015; Avey & Hobbs, 2013; Barbosa & Silva, 2017; Brunacini, 2019; Bruneau et al., 2020; D. Hilty et al., 2020; Goran, 2012; Pappas et al., 2019; R. Wong et al., 2020; Shortridge et al., 2016; Skiba et al., 2014; Slovensky et al., 2017; Smith-Strøm et al., 2016; Vessey et al., 2015; Virtual Care Task Force, 2020). Slovensky et al. (Slovensky et al., 2017) report that an effective team can use multiple delivery models, including the virtual model (Slovensky et al., 2017). Specifically, they believe that the ability of all professionals to work effectively as a team while valuing cultural competence is critical to the success of the virtual healthcare model.

The role clarification competency in telehealth was found to be an essential element for several papers included in this scoping review (Corriveau et al., 2020; Crumley et al., 2018; Gifford et al., 2012; Goran, 2012; Henry et al., 2021; Pappas et al., 2019; Skiba et al., 2014; Vessey et al., 2015). Indeed, Goran et al. (Goran, 2012) emphasized that recognizing the value of one’s colleagues’ role is paramount to forming a dedicated team, and for this reason, valuing the role, knowledge, and expertise that each member can contribute is essential. Corriveau et al. (Corriveau et al., 2020) agree with these findings. They mention that when professionals do not perceive any recognition or feel that they only receive negative comments regarding their role, this can result in a lack of motivation and a lower level of trust. The low level of trust between different members of an interprofessional team may negatively impact their desire to collaborate (Corriveau et al., 2020).

Finally, collaborative leadership has also been shown to be an essential competency for a care team to be effective in telehealth settings (Bruneau et al., 2020; Crumley et al., 2018; Nelson et al., 2011; Pappas et al., 2019; Smith-Strøm et al., 2016; Thye et al., 2018; van Houwelingen et al., 2016). Crumley et al. (Crumley et al., 2018) reported that telehealth typically involves a tripartite interaction between the patient, the physician, and the remote expert. This interaction is based on a shared leadership approach. Each, including the patient, takes shared responsibility for the processes chosen to achieve the outcomes. Pappas et al. (Pappas et al., 2019) also reported that telehealth is ideal for shared decision-making because it allows clinicians to communicate with patients about their care. Then again, even though the clinician communicates with the patient remotely, the relationship is based on a shared leadership model.

Facilitators and barriers to interprofessional collaboration in telehealth

It was also possible to identify fewer determinants of collaboration practice. The emerging themes are described in Table 2, which presents the facilitators and barriers professionals face when collaborating in telehealth settings.

Table 2. Facilitators and barriers to interprofessional collaboration in a telehealth context.

Facilitators	Barriers
Inclusion of a champion in the clinical setting (Allen et al., 2015; Bruneau et al., 2020; Crumley et al., 2018; D. Hilty et al., 2020; Peters, Sousa, et al., 2015)	Lack of knowledge regarding technology (Crumley et al., 2018; Galpin et al., 2020; L’Esperance & Perry, 2016; Skiba et al., 2014; Smith-Strøm et al., 2016; Vessey et al., 2015)
Activities to promote engagement among interprofessional team members (Filipova, 2015; Peters, Sousa, et al., 2015)	Lack of time (Galpin et al., 2020; Smith-Strøm et al., 2016)
Frequent assessment of needs and requirements regarding training in changing emerging technologies and provision of targeted training to professionals (Avey & Hobbs, 2013; Galpin et al., 2020; L’Esperance & Perry, 2016; Shortridge et al., 2016; Vessey et al., 2015)	Lack of confidence of professionals regarding their abilities (Avey & Hobbs, 2013)
Promotion of the pros of using technology to show positive leadership in collaboration and confidence regarding technology (Avey & Hobbs, 2013; D. Hilty et al., 2020; L’Esperance & Perry, 2016; Vessey et al., 2015; Virtual Care Task Force, 2020)	Challenges in the creation of a trust-based relationship (Barakat et al., 2013; Barbosa & Silva, 2017; Brandt et al., 2018; D. M. Hilty et al., 2018; Galpin et al., 2020; Virtual Care Task Force, 2020)
Availability of reliable and precise technological devices (The College of Family Physicians of Canada, 2021; Virtual Care Task Force, 2020)	Reluctance to collaboration/Reluctance to change (Allen et al., 2015; Avey & Hobbs, 2013; L’Esperance & Perry, 2016; The College of Family Physicians of Canada, 2021)
Availability of professional support from a qualified person to fix any problems linked to the technology (e.g. IT expert) (Shortridge et al., 2016)	Technological issues (sound quality, network delays) (Allen et al., 2015; Galpin et al., 2020; L’Esperance & Perry, 2016; Shortridge et al., 2016; Smith-Strøm et al., 2016; The College of Family Physicians of Canada, 2021)
	Inadequate level of initial training among professionals (Allen et al., 2015; Brandt et al., 2018; D. Hilty et al., 2020; Galpin et al., 2020; Goran, 2012; Kujala et al., 2019; Skiba et al., 2014; Smith-Strøm et al., 2016)

Facilitators

The studies included in our review report that the following elements facilitate interprofessional collaboration in telehealth: the presence of a champion in the clinical setting (Avey & Hobbs, 2013; Bruneau et al., 2020; Filipova, 2015; Kujala et al., 2019; Nelson et al., 2011), frequent assessment of needs related to technology, and training of professionals (Barakat et al., 2013; Barbosa & Silva, 2017; Corriveau et al., 2020; Goran, 2012; R. Wong et al., 2020) and promoting the benefits of using the technology (American Psychiatric Association, 2020; Barakat et al., 2013; Corriveau et al., 2020; Goran, 2012; Kujala et al., 2019).

A key ingredient for successful interprofessional collaboration in telehealth is the presence of a team member who acts as a champion (Avey & Hobbs, 2013; Bruneau et al., 2020; Filipova, 2015; Kujala et al., 2019; Nelson et al., 2011). For example, as mentioned by Filipova et al. (Filipova, 2015), having a staff member who is a telehealth « champion » raises staff awareness of the value of virtual care. Teams see the champion is seen by their team as an ambassador for telehealth. They also act as a care team leader and frequently communicate with all levels of professionals to mobilize team buy-in and facilitate the implementation of telehealth (Government of Canada, 2019).

Several authors have also reported that to make virtual collaboration effective, professionals must be adequately trained in remote communication (Barakat et al., 2013; Barbosa & Silva, 2017; Corriveau et al., 2020; Goran, 2012; R. Wong et al., 2020). Corriveau et al. (Corriveau et al., 2020) also explain that practice and experience are crucial for developing collaborative competencies in telehealth, as practice consolidates what has been learned in training. Being adequately trained also leads to a positive and confident attitude toward technology, which positively influences the development of competencies (Goran, 2012).

Finally, reliable, accurate, and easy-to-use equipment (American Psychiatric Association, 2020; Canadian Nurse Association, 2017), with adequate information technology and technology support (R. Wong et al., 2020), are other elements that facilitate implementing efficient and effective telehealth collaboration.

Barriers

As for barriers, the authors noted several elements. For example, six studies identified a need for more knowledge of the technology (Avey & Hobbs, 2013; Barakat et al., 2013; Barbosa & Silva, 2017; Corriveau et al., 2020; L’Esperance & Perry, 2016; Smith-Strøm et al., 2016). Corriveau et al. (Corriveau et al., 2020) explain that this lack of knowledge led to decreased motivation, increased anxiety, and cancellation of virtual training clinics among nurses. This lack of knowledge can partly be explained by the lack of computer education in the respective curricula of other health professional disciplines and technological support (Skiba et al., 2014). Technological difficulties have been identified as one of the greatest challenges to implementing an effective telehealth collaboration system (Barbosa & Silva, 2017; Bruneau et al., 2020; R. Wong et al., 2020). Bruneau et al. (Bruneau et al., 2020) described poor sound quality and poor internet connection as essential barriers. Wong et al. (R. Wong et al., 2020) also described that problems with sound and image quality during videoconferences between professionals could impede the quality of collaboration.

Six studies have reported that the absence of a trust-based relationship between professionals is an unfavorable condition for telehealth (American Psychiatric Association, 2020; Barbosa & Silva, 2017; Brandt et al., 2018; D. Hilty et al., 2020; Fraser et al., 2017; Shortridge et al., 2016). This relationship of trust seems more challenging to establish virtually (Brandt et al., 2018). For example, in the study by Barbosa et al. (Barbosa & Silva, 2017), professionals reported that distance complicates the communication process because it is more challenging to develop a trusting relationship in a virtual setting due to the lack of face-to-face interpersonal interactions (Barbosa & Silva, 2017). It also appears that working virtually makes it challenging to understand the nonverbal dimension and can hinder communication (Barbosa & Silva, 2017). This highlights the concern of some authors reporting that the physical distance between professionals in remote interactions may compromise the richness and complexity of eye contact, gaze, posture, facial expressions, and body positioning, which are cues that could alter the meaning given to verbal expressions (Barakat et al., 2013; Barbosa & Silva, 2017). In the presence of a preexisting professional relationship, it is easier for professionals to engage a colleague in collaborating virtually (Fraser et al., 2017).

Change management, when implementing new technology or a new way of working within a team, is also seen as a barrier to interprofessional collaboration. L’Espérance et al. (L’Esperance & Perry, 2016) report that using a new virtual collaborative platform is time-consuming and adds to the workload (L’Esperance & Perry, 2016). Professionals interviewed reported that additional effort was required to respond to patients’ diabetes results in uploads outside of consultation hours and during consultation hours (L’Esperance & Perry, 2016).

Another barrier identified concerns the need for more funding for telehealth (Barakat et al., 2013; Filipova, 2015). Filipova et al. (Filipova, 2015) report that healthcare institutions are less inclined to invest in technology systems that enable virtual communication due to many competing financial priorities and a lack of financial incentives. This leads to a significant delay in virtual care delivery and collaboration between remote professionals (Barakat et al., 2013).

Finally, several studies have reported significant gaps in the initial training of professionals for telehealth (Barbosa & Silva, 2017; Bruneau et al., 2020; Kujala et al., 2019; L’Esperance & Perry, 2016; Shortridge et al., 2016; Skiba et al., 2014; Slovensky et al., 2017; Smith-Strøm et al., 2016). Slovensky et al. (Slovensky et al., 2017) suggest, among other things, that too often, educational institutions presume that clinicians will learn telehealth competencies through a “learning on the job” process or that students who have grown up with the technology already possess the required competencies. However, studies report that virtual collaborative practice is a major, rapidly growing technological phenomenon that is still unfamiliar to professionals, including young people, requiring significant educational reform of health curricula (Skiba et al., 2014; Slovensky et al., 2017). Wong et al. (R. Wong et al., 2020) found that training medical residents to facilitate interprofessional teleconferences increased their reported likelihood of using this type of collaboration in the future.

Discussion

This paper aimed to 1) describe telehealth interventions in the context of interprofessional collaboration; 2) identify the facilitating competencies for interprofessional collaboration in telehealth and 3) formulate recommendations to support the adjustment of initial and continuing education to the context of collaborative telehealth care. The presentation of the results enables us to make the following observations: 1) Competencies are implicitly present in literature; 2) Although this is a core competency, conflict resolution is absent from the discourse of the authors of the identified studies; 3) Digital inequity is an element that is frequently cite and; 4) Continuing training and education to support telehealth learning should be strengthened.

Overall, although the competencies required in interprofessional collaboration shown in the National Interprofessional Competency Framework (Orchard et al., 2010) are implicitly present in the literature, we still had to use qualitative data analysis techniques to classify authors’ statements as about specific collaboration competencies. Interprofessional collaboration is a relatively recent designation in the field of telehealth that still needs to be clearly defined. Its implicit nature stems from the fact that the problematization of interprofessional collaboration in telehealth is still being formulated. Moreover, it can be challenging to distinguish between the competencies needed for virtual and in-person settings, given the overlapping competencies required in both contexts. This increases the challenge of apprehending the specifics of interprofessional collaboration in telehealth.

While most of the competencies suggested in the National Interprofessional Competency Framework are found either implicitly or explicitly in the studies retrieved, one of them, namely the competency in interprofessional conflict resolution, should have been mentioned despite its crucial role in effective interprofessional collaboration (Cullati et al., 2019). Absenteeism at work, along with staff turnover (Gifford et al., 2012), is partly due to this inability to resolve conflicts and reduced work performance and professionals’ engagement level (Kankanhalli et al., 2006; Massey et al., 2003). This might be explained by the absence or physical distance of a designated person (e.g., a superior) in telehealth. Indeed, there are more opportunities to resolve conflicts when face-to-face. Some barriers have been identified that may impede the development of this skill. For example, challenges in the creation of a trust-based relationship (Barakat et al., 2013; Barbosa & Silva, 2017; Brandt et al., 2018; D. M. Hilty et al., 2018; Galpin et al., 2020; Virtual Care Task Force, 2020) and reluctance to collaborate/reluctance to change (Allen et al., 2015; Avey & Hobbs, 2013; L’Esperance & Perry, 2016; The College of Family Physicians of Canada, 2021) affect the establishment of a healthy relationship between professionals, making it very difficult to resolve a conflict situation in these situations.

Another problem encountered and well documented in this study refers to numerical inequalities, which stakeholders insist on. Digital inequality is defined as inequalities in access and use of digital technologies, both in the availability of electronic devices (smartphones, tablets, or computers) and access to an adequate internet connection (Institut national de santé publique du Québec, 2021). Although breakthroughs in technology increase its use, there are challenges related to access to adequate devices and a need for more resources in ICT support, which hamper the efficient implementation of interprofessional collaboration in telehealth (Institut national de santé publique du Québec, 2021), especially for people who might need more numerical knowledge. According to the studies we retrieved, it is the responsibility of health policy to ensure that both professionals and patients have access to an optimal environment to use telehealth successfully. Indeed, they must be able to rely on the Internet connection and adequate material, as access to ICT experts. The use of technology experienced significant growth in the wake of the COVID-19 pandemic, which increases these needs and the importance of addressing them. Depending on the location, urban or rural, or the patient’s socioeconomic status and type of occupation, there is a clear gap. This disparity is well documented in the literature, mainly in articles from the United States, Canada, and Australia (Borg et al., 2019; Cheng et al., 2020; L. Jones et al., 2017; Schmidt & Power, 2021). Since professionals in remote locations often benefit from lower-quality technological devices and services, there can be a negative impact on collaboration in telehealth and widening gaps in health (Cortelyou-Ward et al., 2020). To avoid a negative impact on interprofessional collaboration, healthcare providers must have complete and adequate access to digital technologies and sufficient IT support (Institut national de santé publique du Québec, 2021).

Government, professional orders, and academic institutions need to educate better and mentor professionals in interprofessional collaboration in telehealth. The description of barriers and facilitators to interprofessional collaboration in telehealth suggests that professionals fully feel they need to be more competent in using technological tools for interprofessional collaboration in telehealth. Indeed, staff training in the mechanics of telehealth is seen as a common adaptation to barriers related to unfamiliarity with technological tools (L’Esperance & Perry, 2016). The more familiar professionals are with the equipment and interprofessional collaboration modalities, the more successful the collaborations. Educational institutions should include the development of competencies related to interprofessional collaboration in telehealth in the initial curriculum of future health professionals. In addition, professional orders should supervise and promote continuing education to develop and maintain these same competencies.

Recommendations

Based on these results, we are providing several recommendations to the different establishments, decision-makers, and professionals to promote interprofessional collaboration in telehealth (see Table 3 below).

Table 3. Recommendations to promote interprofessional collaboration in the telehealth context.

Health government policy

To allow healthcare facilities to invest in state-of-the-art telecommunication devices through major financial incentives enabling their acquisition and adequate IT support.

Post-secondary educational institutions delivering health programs

To offer training on technologies in their initial educational path.

Healthcare facilities

To offer more continued education to professionals, depending on their specific needs.

To ensure that professionals can access good quality and modern equipment to promote their use, in addition to adequate IT support.

To show a positive attitude toward technology to favor positive leadership related to the different types of virtual collaboration

To determine a follow-up and interprofessional conflicts resolution plan tailored to the virtual context for each establishment.

To improve abilities related to conflicts.

To offer clear and complete practical guides to support them in collaborating efficiently with the interprofessional team.

Healthcare professionals

To engage in improving their digital literacy.

To set up strategies that put forward the different aspects of interprofessional collaboration in virtual care.

To acquire skills in risk management for patients’ safety and ethical challenges linked to telehealth and interprofessional collaboration.

Researchers

To study unexpected effects (e.g. referrals to emergencies) of telehealth on patients and health and social services professionals.

To study the cognitive impacts of working remotely on interprofessional collaboration.

Patients

To prepare adequately for virtual appointments using available tools.

Health technologies providers

To facilitate the learning of technological tools and the interoperability between existing tools.

To create apps and software that allow professionals and patients to use different essential skills in interprofessional collaboration.

To support the development of integrative technologies (e.g. Teams, ZOOM, etc.) to support interprofessional collaboration by ensuring that IT experts have access to the required equipment.

To ensure that virtual care remains accessible and the platforms are user-friendly for this modality of care to be permanent and not only a passing trend.

Limitations

Our scoping review has some limitations that are worth noting. First, the criteria we established are a limitation because we may have included only some of the keywords in the literature. Moreover, our search strategy with the provider of research databases (EBSCO) limited our selection of databases. Our choice of research terms may also have influenced the articles we captured. In addition, the results could have been very different if we had limited our search to articles published only in 2020–2021 due to the critical increase in the use of technology in telehealth following the outbreak of the COVID-19 pandemic.

Conclusion

This scoping review aimed to explore the competencies that health and social services professionals need to maintain interprofessional collaborative practice when practicing telehealth. With the explosive expansion of telehealth because of the COVID-19 pandemic, it is essential to guard against a return to silo-based practices that would be enhanced by technologies that are too insensitive to interprofessional collaboration. Telehealth is now a permanent patient care modality. It is, therefore, essential to better support professionals in integrating this new practice by supporting them in the development of their competencies and by providing them with an adequate infrastructure. Telehealth is more than just being able to talk to someone who is not in the same place. It needs to be thought out and designed to reflect what is happening in clinical settings without leaving out specific components of the practice. This scoping review emphasized the main challenges to collaboration in telehealth. Our recommendations will allow clinicians to take concrete actions leading to better collaboration between professionals working remotely. In addition, researchers can also benefit from our recommendations to further work on interprofessional collaboration in telehealth. Since telehealth is still widely used in healthcare despite most organizations having resumed their in-person activities, there needs to be some reflection on how to make this new way of working the most efficient and optimal for patients and professionals involved.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/13561820.2023.2213712.

Additional information

Funding

The work was supported by the CRMUS Research chair on optimal professional practices in primary care and the Social Sciences and Humanities Research Council of Canada

Notes on contributors

Marie-Eve Poitras

Yces Couturier, Ph.D. is a Professor at the Université de Shebrooke. His research focuses on service coordination and integration, interprofessional collaboration, professional practice analysis, service organization and primary care. He has published several reference books on social work and interprofessional collaboration.

Yves Couturier

Marie-Eve Poitras, RN, Ph.D. is a Professor at the Université de Sherbrooke and holds an academic research chair on optimal professional practices in primary care. Marie-Eve research interests include the integration of patients' and professionals' perspectives in clinical, organizational and decision contexts.

Priscilla Beaupré

Priscilla Beaupré, M.Sc. is a kinesiologist and has a master's degree in experimental medicine. She is a research assistant in Professor Poitras' team.

Ariana Girard

Ariana Girard, RN, Ph.D. is a Professor at the Université de Sherbrooke and her research interests include clinical and organizational support practices; professional well-being, mental health issues, primary care, care management, and nursing assessment and monitoring.

Francois Aubry

François Aubry, Ph.D. is a Professor at the Université du Québec en Outaouais. François' research focuses on the analysis of the professional practices of health and social services attendants and auxiliaries, the m anagement and social issues of the practice of attendants and assistants, and the organization of residential resources for the elderly.

Vanessa T. Vaillancourt

Vanessa T. Vaillancourt, M.Sc. is a biologist and has master's degree in experimental medicine. She is the research coordinator in Professor Poitras' team.

Jean-Daniel Carrier

Jean-Daniel Carrier, Ph.D. is a physician specializing in psychiatry and a post-doctoral fellow at the Douglas Mental Health University Institute, McGill University. His interests include cognitive-behavioral therapy for anxiety disorders, including for healthcare professionals.

Laurie Fortin

Laurie Fortin, RN is a clinical management consultant at the critical care sector nursing department of the health establishment of Saguenay Lac-St-Jean.

Julie Racine

Julie Racine, MA. is a social worker and a planning, programming and research officer professional coordination center for Applied Research in Psychosocial Intervention. She is working on the creation of training courses for health professionals.

Caroline Cormier

Caroline Cormier, M.SC. has a bachelor's and a master's degree in psycho-education. She was a research assistant in Professor Poitras' team.

Anaëlle Morin

Amélie Boudreault, M.Sc. has a bachelor's degree in psychology and a master's degree in experimental medicine. She is a research assistant is Professor Poitras' team.

Anaëlle Morin, RN is a master student supervised by Professors Poitras ad Couturier. She is interested in the role of patient-partners in training of nurses.

Monica McGraw

Monica McGraw, RN, M.SC. is a doctoral student supervised by Professor Poitras. She studies the Experience and Operationalization of Interprofessional Telehealth Collaboration in Primary Care during COVID-19.