Appendix C
October 9, 2013, Poster Session: Abstracts
CONTENTS
C.1
STUDENT PARTICIPATION AS A STRATEGY FOR TRAINING LEADERSHIP AND BECOMING CHANGE AGENTS
Jan De Maeseneer, M.D., Ph.D., Sofie Dhaese, Inge Van de Caveye, Bart Vergauwe, and Sarah Bogaert, M.A. Ghent University
Background The Lancet Commission report requires medical faculties to train health professionals who have leadership attributes and who can act as change agents. Both the conceptual background of these requirements and the appropriate educational strategies are actually unclear. There is still a lot of debate on the concept of transformational leadership and how it could be learned (see Box C-1).
Aim To assess to what extent the different ways student participation in the medical training at Ghent University contributes to acquiring skills that could be useful for transformational leadership.
Results Medical students are organized via a Student Workgroup on Medical Education (SWME), founded in 1999. Students were very much involved in the fundamental curriculum reform that took place: from a traditional discipline-based curriculum toward an integrated contextual
BOX C-1
Definition of Transformational Leadership
Jan De Maeseneer, Ghent University, and Dawn Forman, Curtin University, proposed the following definition for transformational leadership:
Transformational leadership occurs when leaders articulate the purpose and the mission interactively (Gumusluoglu and Ilsev, 2009) with the group and are intellectually stimulating the group, championing innovation, and inspiring group members to become change agents. Transformational leadership is characterized by connecting the member’s sense of identity and self to the project and the collective identity of the organization by being a role model for the group members that inspires them and keeps them interested. Transformational leadership challenges group members to take greater ownership and strategic understanding of the context, the strengths and the weaknesses that have to be addressed in the change process. Transformational leadership creates a climate of trust, a process of empowerment, and guarantees safety so that group members can look beyond their own self-interest (Bass and Avolio, 1994) in order to make change happen.
medical curriculum, organized in “units” and “lines” with a focus on problem and community orientation. Students participate in the committees that built the different “units” and “lines,” in the Educational Commission, in the Faculty Council, and in different, broader government structures of the university. SWME organizes monthly meetings, a research symposium, and a yearly seminar, where students spend 1 week of their holidays to study and analyze the actual curriculum and formulate proposals for improvement, presenting a 30- to 40-page report to the Educational Committee. This leads to a high degree of “ownership” of the curriculum by the students. In the recent reform from 7 to 6 years undergraduate training, the students formulated the first proposals for the new curriculum. Student proposals are examined thoroughly and very often implemented partly or totally. Moreover, the students constructed the electronic repository of the learning materials of the whole curriculum, making it searchable for students and teachers.
In a first attempt to assess what could be the effect, an exploratory questionnaire was sent to over 50 students who were active in SWME. A Likert scale (1–5) was used to make the assessment. Four items focused on the function of a physician, and 20 items assessed the extent to which students felt their participation contributed to the development of some transformational leadership competencies.
Students find that it is their responsibility to take initiatives to improve quality of care (4.52) and to improve accessibility of care (4.23). As far as the skills and competencies that the students learned through student participation were concerned, the highest scores were given to “dealing with decision making in an ethical way” (4.25), “defending the view points of the group I represent” (4.34), “formulating compromises when there are different opinions in a group” (4.15), “tackling problems in an effective way” (4.38), “anticipating future developments” (4.18), “developing a vision for the future” (4.30), and “formulating proposals for improvement” (4.33).
From the free-text comments it became clear that students were able to illustrate with concrete examples what those skills and competences meant and how they had been developed. Especially the importance of the SWME meetings, the 1-week SWME seminar, participation in commission and working parties, being involved in curriculum reform, and representing fellow students was illustrated frequently.
From the responses it became clear the students acquired several leadership skills, and they learned to act as change agents.
Conclusion Student participation in the development and quality assurance of the medical curriculum, and the existence of a formal student organization, together with an open attitude of the staff toward student
participation, may contribute to the learning of transformational leadership. It will be important to look how these skills will further develop during specialty training and in professional life.
C.2
TRANSFORMATIVE TEACHING AND ASSESSMENT IN AN INTERPROFESSIONAL APPLIED DECISION-MAKING COURSE
Kathrin A. Eliot, Ph.D., Irma Ruebling, P.T., M.A.,
and Rebecca Banks, M.S.W.
Saint Louis University
Objective To explain the innovative model used in an interprofessional education (IPE) course to help students analyze and reflect on complex patient situations.
Background The IPE curriculum at Saint Louis University offers a longitudinal, integrated curriculum across baccalaureate-level degree programs for health care professional students. A three-credit course, Applied Decision Making in Interprofessional Practice, prepares students to demonstrate the tenets of patient-centered care through the engagement of ethical principles in a three-step decision-making model and the development of a caring response as an interprofessional (IP) team member.
Process As part of the course requirements, students complete an analysis and written reflection on case studies that relate to the topics covered by lectures and reading assignments and require the application of patient-centered care and ethical principles. The three-step process consists of an individual analysis of the case, an IP team analysis of the case and a recommended course of action for the team to take, and an individual critical reflection on the case and the team decision-making process.
Outcomes The first two steps in the critical reflection assignment provide students with social interaction and experiential learning in which IP teams discuss options and come to consensus for patient-centered care approaches to real-life cases. The third step in the assignment encourages reflective learning in which students assess changes in their views about the case and consider the impact of this transformation on their future actions.
Implications Students who have participated in this experience report a transformation in their views of the cases and an increased ability to interact with an IP team. Course outcomes and feedback suggest that students are able to assess their responses to ethical situations and the need for communication among the IP team and patients.
Margaret Clark Graham, Ph.D., Kristie Flamm D.N.P.(c), M.S.N., Teresa Smith, M.S., Matthew Stone, M.S., Ericia Howard, M.S., R.N., Caroline Graham, M.S.Ed., Julie Kennel, Ph.D., Lori Murphy, M.S.W., and Tiffany Shin, Pharm.D.
The Ohio State University
The purpose of this poster presentation is to discuss the development of the Ohio State University Total Health and Wellness center (OSU THW), a nurse practitioner (NP) led interprofessional collaborative practice (IPCP) health care center that integrates mental health services into primary care. A major focus of the center is to improve the health outcomes of patients, families, and communities by supporting the development and implementation of an innovative IPCP model. This NP-led TEAMcare model is implemented with a collaborative team composed of highly functioning diverse health professionals, including family and psychiatric mental health nurse practitioners, registered nurse (RN) case managers, dietitians, mental health counselors, and social workers. TEAMcare is a care management intervention that integrates collaborative depression care with systematic chronic illness care and treat-to-target interventions designed to improve multiple conditions (diabetes, depression, and coronary heart disease). Key components of the intervention are a patient-centered focus, collaborative goal setting, practical care planning, and consistent targeted patient and multidisciplinary health care team management (McGregor et al., 2011). The NP-led IPCP allows health care professionals and students the opportunity to practice IPCP through the delivery of primary, secondary, and tertiary care to persons throughout the life span. The interprofessional team of health care providers emphasizes health promotion and wellness, regardless of the person’s state of health, and focuses on the prevention and management of chronic diseases, the most common and costly of all health problems, affecting one out of every two individuals in the United States (CDC, 2009; Harris and Wallace, 2012). The OSU THW center serves as a site for clinical placement for nurse practitioner, nursing, pharmacy, social worker, and dietetic students. Students participate in weekly TEAMcare meetings in which the disciplines work together to develop treatment plans with input from patients. The weekly meeting is held via a conference call that allows online students an opportunity to be a part of the team. The distance students use telehealth in working with their patients to achieve the patient’s treatment goals.
Jehu E. Iputo, M.B.Ch.B., Ph.D.
Walter Sisulu University
Background The scale and depth of the economic and social disparities in health care in South Africa is well documented. To address the issue of social responsiveness, principles such as recruitment from rural and underserved communities, integrated clinical training, and longitudinal rural rotations have been implemented in the physician training program at Walter Sisulu University (WSU). To date there has been no formal evaluation of the effect of these educational strategies on the social responsiveness of the WSU medical graduates.
Aim This paper presents the initial data from an ongoing study about the outcomes of teaching and learning strategies that seek to improve the social responsiveness of health care professionals in South Africa. It explores the career choices and the geographical location of the WSU medical graduates who are certified for independent practice.
Outcomes To date 1,423 doctors have graduated from the WSU program. Eighty-five percent are from rural areas of the Eastern Cape and Kwazulu Natal Provinces of South Africa, 10 percent from large cities, and 5 percent from overseas. Of those graduates, 931 have been certified for independent practice. Of those, 3.6 percent are deceased, 4.2 percent have emigrated, 16 percent are practicing in large cities, and 73 percent are practicing in rural areas of the Eastern Cape and Kwazulu Natal. Seventy-eight percent work within the public sector (either full-time or part-time), whereas 22 percent are in full-time private practice. Sixty percent are in general practice, whereas 35 percent have either specialized or are in specialist training programs. Internal medicine, pediatrics, obstetrics and gynecology, and general surgery are the most favored disciplines.
Conclusions Graduates of the WSU are being retained within the country and more importantly within the deprived rural areas. Most of the WSU graduates practice a primary care discipline. The WSU policy of recruiting locally and training locally has led to higher retention of primary care physicians in the rural areas.
Susan Kimble, R.N.
University of Missouri Kansas City (UMKC)
Background This project created an Interprofessional Collaborative Practice Model (IPCP) at two community-based urban clinics extending classroom IPE experiences. IPE is a growing area of interest in the health care professions, focused on roles and responsibilities, values and ethics, communication, and teamwork (IPEC Expert Panel et al., 2011). The project provided innovative opportunities, placing health professionals and graduate students from the UMKC’s Schools of Nursing, Dentistry, and Pharmacy. The objective was improving health outcomes in patient-centered care through IPCP, which provided primary, preventative, and mental health care services to underserved populations. Both clinics are located in a health professional shortage area serving an urban population where 50 percent is living at or below 200 percent of the federal poverty level, and approximately 41 percent of patients are uninsured with 30 percent receiving Medicaid (RWJF, 2011).
Methods Data was acquired regarding students’ attitudes and readiness about IPE, and how over time, those attitudes changed as a result of IPCP placement. The hypothesis was that attitudes and readiness become more positive following IPE experiences. A series of pre/post surveys was administered to student participants during semester-long clinical rotations. Pre/post tests included the Attitudes Toward Health Care Teams Scale, Readiness for Interprofessional Learning Scale, Team Skills Scale, and Cultural Competence Assessment with the Team Fitness Test added post-test. Comparison data were analyzed between the pre/post test results.
Results Collected data measured the effectiveness of the IPE activities that resulted in team informed care decisions regarding vulnerable patient populations. A secondary outcome was of improved communication. The project created a platform for open and honest communication and building a culture of trust. This affected both health delivery and desired patient outcomes.
Conclusions This project is ongoing, and survey outcomes will inform future IPE curriculum. Assessment of the survey data will assist additional
curricular content for this cohort, with strategies in preparing future leaders for the health care arena.
Key words Interprofessional education, cultural competence, underserved and vulnerable populations
Learning objectives:
- Discuss the importance of establishing IP clinical team opportunities for developing IPE community engagement.
- Develop effective clinical student preparation prior to participation in an IPE clinical setting.
- Use data from IP clinical teams regarding interprofessional communication as a foundation for improved patient outcomes and health care delivery.
- Discuss the importance of team preparation in support of the new professionalism in community health clinics.
C.6
NUTRITION EDUCATION IN THE MEDICAL SCHOOL: WHERE DO WE STAND?
Carine M. Lenders, M.D., M.S., Sc.D.,1,2,3 Kathy Ireland, M.S.,1,2,3 Cynthia Schoettler, M.P.H.,2,3,4 and Emily Keefe1,2 for the Nutrition VIG and SNAAC
1Nutrition & Fitness for Life Program, Boston University Medical Center (BUMC),
2Nutrition Vertical Integration Group (Nutrition VIG),
3Boston University School of Medicine (BUSM), and
4Student Nutrition Awareness & Action Council (SNAAC), BUSM
Most common causes of death in the United States are preventable and related to nutrition. A nutrition vertical integration group (VIG) consisting of faculty (e.g., educators, M.D., R.D.) and students was created in 2007 to assess the curriculum and develop a sustainable model of nutrition medicine education.
The initial objectives were to (1) assess the status of nutrition education in the medical school curriculum and identify areas for improvement, (2) enhance nutrition-related clinical skills of students and faculty, and (3) identify opportunities in postgraduate training at Boston University (BU).
The nutrition VIG developed an educational plan using a novel student-centered model of nutrition medicine education that focuses on mentored
medical student extracurricular activities to develop, evaluate, and sustain nutrition medicine education. Boston University School of Medicine (BUSM) uses a team-based approach focusing on case-based learning in the classroom, practice-based learning in clinics, and extracurricular activities.
Student Nutrition Awareness & Action Council (SNAAC) participants are paired with dietetic interns from Sargent College, conduct surveys, organize seminars, develop training material, and participate in multidisciplinary rotations, community outreach, and advocacy. As a result, medical students have received local and national awards. The medical school course directors indicate that most preclerkship nutrition objectives adopted by the nutrition VIG (the National Heart, Lung, and Blood Institute objectives) are met by the end of the 4-year curriculum, and student U.S. Medical Licensing Examination (USMLE) scores in nutrition have improved. However, students still feel ill prepared to advise future patients on nutrition.
SNAAC is pivotal to the development of professional team work, educational material, and sustainability of the nutrition VIG’s goals. There is a need to better define priority areas and competencies in nutrition medicine, especially during the clerkship years. Medical students can play a critical role as nutrition advocates and agents of change across medical schools, while national standards are being developed with the New Balance Foundation.
Jennifer Morton, D.N.P., M.P.H., Karen Pardue, Ph.D., R.N., and Shelley Cohen Konrad, Ph.D. University of New England
Background Educating health professionals to deliver safe, patient-centered care in a fast-paced, ever-changing health care milieu requires collaborative teamwork that begins in the classroom and translates to the community. While, fundamentally, it is well understood that team-based care is good for patients, there is a paucity of literature looking at the evaluative effectiveness that collaborative teamwork has, and its future impacts, as we navigate through the daunting land of health care reform.
Goal The Health Resources and Services Administration (UD7-NEPQR) CHANNELS (Community, Health, Access, Network, Navigate, Leadership, Service) Project’s goal is to develop nurse leaders and interprofessional teams of students and health professionals to improve outcomes for Maine’s immigrant and refugee communities.
Methods CHANNELS is implementing a multifaceted approach that includes the following:
- Educational activities: Integrated curriculum for eight disciplines in collaborative learning environments
- Training activities: Expanding a community health outreach worker (CHOW) navigation model, development and rollout of population-focused nurse leader institute
- Service delivery: Opening a community-based IPC clinic at a local housing authority; conducting a targeted oral health screening, prevention, and treatment program; and community-based health promotion programming
Methods and evaluation The CHANNELS team has developed and begun implementation of a comprehensive evaluation plan. The following program-specific innovations will be measured using reliable and valid tools:
- Educating all health professions students in an IPE environment to cultural sensitivity and health equity
- Introducing patient navigation in the form of CHOW’s as critical members of the interprofessional team
- The effects of nurse-led care in community-based population health.
Additionally, all UD7 evaluators are working in concert to develop a standardized evaluation to measure the difference that collaborative team-based care aligned with the Institute for Healthcare Improvement’s Triple Aims (population outcomes, patient-centered care, lower costs) has on this population of interest.
Summary To fully capture and embrace interprofessional care as best clinical practice, we must embrace IPE as best educational practice. While discipline-specific formative and summative assessment remains important for developing a practice ready clinician, IPE is an essential integrated weave that addresses (1) values and ethics, (2) roles and responsibilities for team-based care, (3) interprofessional communication, and (4) team-based care and collaborative leadership. The CHANNELS Project brings interprofessional education and interprofessional collaboration (IPE and IPC) from classroom to community by embracing our community of interest the immigrant and refugee communities of Portland, Maine, as natural partners on the collaborative health team.
C.8
EVALUATING COMPETENCIES IN IPE
Whitney Nash, Ph.D., APRN University of Louisville Research Foundation, Inc.
Purpose To describe existing assessment methods and new measures used to evaluate student competencies and outcomes of a technology-enhanced IPE program for advanced nurse practitioners (ANPs), family nurse practitioners (FNPs), and dental students focused on the oral-systemic health connection.
Background National and local oral health data indicate disparities exist. Improved oral health care and integration of it with primary health care are critical. The oral-systemic health connection is poorly understood and not reinforced in health professions education. IPE is needed to set the expectation that collaborative practice among all health care disciplines is the standard. In this project, technology supports the delivery of the IPE curriculum focused on the oral-systemic health connection to ANP/FNP and dental students and provides the foundation for documenting clinical care and communication via an electronic health record.
Methods The first portion of the curriculum focuses on IPE core competencies and is delivered in face-to-face seminars along with online, Web-based peer-to-peer problem-based learning exercises for ANP/FNP students in their first year of course work and to sophomore dental students. The Web-based Smiles for Life: A National Oral Health Curriculum is also used. Pre/post test measures collected in this phase and at the end of the program include
- A team-developed knowledge assessment questionnaire based on the core competencies of IPE
- Readiness for Interprofessional Learning Scale (McFadyen et al., 2005)
- TeamSTEPPS Teamwork Attitudes Questionnaire (American Institutes for Research, 2008)
- Self-Efficacy in Functioning as a Member of an Interdisciplinary Team Scale (team developed)
Students also take an integrated interdisciplinary physical health assessment course together and work in interdisciplinary teams to practice their skills. Peer evaluation of team member effectiveness is assessed at the end of the course using the Team Member Effectiveness Questionnaire (team developed). Each team member (groups of three to four members)
rates themselves and other members of their team; feedback is provided in aggregate form. Physical assessment skills and competencies in oral communication are evaluated via the Standardized Patient (SP) Program, which uses highly trained educators to portray patients with a wide variety of symptoms and illnesses. Students perform physical examinations on SPs, including an extensive oral, head, and neck exam and take a medical history. Faculty evaluate students’ performance in conducting the exams using the Skill in Conducting a Head-to-Toe Checklist, developed by School of Nursing faculty. SPs also give detailed feedback to each student. At the end of each course, students complete standard university course evaluations. They also complete the team-developed Student Satisfaction with the IPE Experience Scale.
ANP/FNP students begin clinical rotations during their second year and document patient health histories, medications, physical assessment findings, and written consultations using the Typhon Group Nurse Practitioner Student Tracking System, LCC; data on dental assessments performed, dental problems identified (ICD-9 codes), and dental referrals made are collected. Oral, written, an electronic presentation of clinical data are assessed by ANP/FNP faculty using the Faculty Evaluation of ANP/FNP Student Clinical Performance in Practice Sites Form (team developed). Additional variables and their measures include
- Number of student practicum experiences in an interprofessional environment in federally funded health care settings and with underserved populations—Typhon Tracking System
- Bureau of Health Professions annual performance data—Office of Student Services data base and Typhon
Results Data from a comparison cohort that did not participate in the program were collected in February 2013, and analysis is in process. Data from the first cohort to participate in the IPE Program (IPE Seminar and Integrated Physical Assessment courses) were collected in May and August 2013 and are currently being entered and 100 percent verified. Data on evaluation of program outcomes and the psychometric properties of scales used will be reported as will recommendations for future methods of assessing competencies in interprofessional education/learning.
Conclusion This technology-enhanced IPE program has the potential to increase quality, access to care, and health care delivery. Our team developed new tools to evaluate competencies of ANP/FNP and dental students. All measures used are in the public domain, are easy to integrate into IPE education, and assess competencies at the individual, team, and organizational levels. The effects of the program and its evaluation methods may
lead to a change in practice patterns to include a thorough oral health assessment that will contribute to recognition of oral-systemic health problems, patient education on the importance of care and need to access oral care, and collaborative management of chronic oral-systemic diseases by nurses and dentists.
Bjorg Palsdottir, M.P.A., and Andre-Jacques Neusy, M.D., D.T.M.&H. Training for Health Equity Network (THEnet)
While reducing inequities is complex and requires the involvement of many stakeholders, health professional schools (HPSs) can—and should—play a central role in attaining universal health coverage. HPSs produce the health care providers, scientists, policy makers, and managers that perform the research and interventions that health systems need. They also influence the values, worldview, behaviors, and actions of its graduates with potentially wide-ranging effects throughout the health system. However, few institutions—in high- or low-income countries—hold themselves accountable for producing outcomes aligned with health workforce, health, and health system needs.
Additional research on how to maximize the positive contribution of HPSs to health system development is needed. A small group of HPSs in high- and low-income countries focusing on underserved populations and striving toward greater social accountability founded the Training for Health Equity Network (THEnet) in 2008 to address this need. These schools share a commitment to address the causes of health inequity and support the development of primary care–oriented health systems in their respective regions. Community engagement, hardwired into all aspects of their work, is at the heart of their success.
The schools jointly developed THEnet’s Evaluation Framework for Socially Accountable Health Professional Education. It identifies key factors affecting a school’s ability to positively influence health outcomes and health systems performance, and develops ways to measure them across institutions and contexts. The Framework, which is context sensitive, includes key components, each linked to a series of aspirational statements, indicators, and suggested measurement tools. It was successfully implemented in different contexts. By unpacking how academic institutions can impact health system development, the Framework opens up promising space for
cross-disciplinary research on how HPSs can and must transform to speed up progress toward greater health equity and universal health coverage.
Key terms Equity, social accountability of health professional schools, evaluation of academic impact, innovation, academic research partnership
Kathryn Puskar, Dr.P.H., Ann Mitchell, Ph.D., Susan Albrecht, Ph.D., Linda Frank, Ph.D., John O’Donnell, Dr.P.H., Holly Hagle, Ph.D., and Dawn Lindsay, Ph.D. University of Pittsburgh School of Nursing
Purpose The purpose is to present two grants funded by the Health Resources and Services Administration (HRSA) that assess competencies in interprofessional education and team-based care focusing on the patient-centered problem of alcohol and other drug use. Team-based care, communication across discipline roles, use of simulations, multiple technologies (i.e., Google Hangout, Articulate, Moodle, WebEx, and REDCap), and online user-friendly access were emphasized. Challenges and opportunities to integrate interprofessional education to improve the competencies of health care students and practitioners resulted in more interprofessional understanding and better patient care.
Significance Health care professionals are key providers who can perform an easy, evidence-based practice screen for alcohol and other drug use with all patients across settings. Today’s patients are admitted to hospitals with multiple health conditions that are complicated by substance use. More than 23 million individuals in the United States are identified as needing treatment for alcohol and/or other drug problems, however only one in five receive treatment. The American College of Surgeons requires Level I and II Trauma Centers to screen for alcohol use during assessments, and the U.S. Preventive Services Task Force recommends that clinicians screen for and provide brief counseling interventions to reduce alcohol misuse. The University of Pittsburgh School of Nursing and the Institute for Research, Education, and Training in Addictions developed an innovative transdisciplinary educational curriculum focusing on interprofessional practice for students and working health care professionals. IPCP teams were composed of students in nurse anesthesia, dental students and residents, and dental hygiene; and health care professionals in nursing, public health,
and behavioral health. The IPCP provides 8 face-to-face and online hours of modules on substance use, interactive case studies designed to include IPCP content, interprofessional dialogues with site cases, and focus groups. The goal is to improve the capacity of health care providers to work interprofessionally through learning the evidence-based practice of screening, brief intervention, and referral to treatment. Free continuing education units are also provided.
Evaluation and outcomes Using pre- and postintervention survey design, data are collected at five time points. Assessment questionnaires include
- Interdisciplinary Education Perception Scale,
- Readiness for Interprofessional Learning Scale,
- Alcohol and Drug Perception Questionnaires, and
- Client Satisfaction Scales.
Data analysis of a sample of 100 is in progress.
Implications for practice Substance use is a worldwide public health priority. Annually, 2.5 million people die from the harmful use of alcohol with resulting accidents, violent behavior, and other societal costs. Through IPCP, health care professionals can better understand their roles in substance use risk reduction through intercollaborative teamwork.
C.11
HEALTH INFORMATICS AS A BRIDGE TO THE UNDERSERVED: PRIMARY CARE STRATEGY
Gayle Roux, Ph.D., R.N., NP-C Texas Woman’s University
In the Institute of Medicine (IOM) workshop summary, Establishing Transdisciplinary Professionalism for Improving Health Outcomes, individual experts characterized transdisciplinary professionalism as “a shared social contract that ensures multiple health disciplines, working in concert, are worthy of the trust of patients and the public” (IOM, 2014, p. 1). Texas Woman’s University (TWU) has used informatics and technological advances in health care to create an interprofessional cultural change in the education of graduate students in nursing, physical therapy, occupational therapy, and nutrition science. Historically at TWU, students have been educated primarily within their own discipline. In the HRSA grant project, informatics combined with recent health-promotion technologies were used to develop four new courses and revise two existing courses to
lead the students from data to information to knowledge to collaboration across professions.
Improvements in population health outcomes TWU created interdisciplinary educational cases focused on implementation of informatics and other health care technologies to improve rural and primary care health outcomes. The first assessment, Tiny Town, Texas, is the story of a real clinic in underserved, rural Texas where the sole provider in a radius of 40 miles is an FNP. This FNP was available to the interprofessional teams for interview and visits to Tiny Town. Doctoral students were divided into interprofessional teams who conducted assessments of the micro-, meso-, and macrosystem for Tiny Town, analyzed the workflow of the clinic, assessed patient needs, determined current and future revenue sources, and provided plans to implement services. The first interprofessional cohort to work with the Tiny Town case consisted of 24 doctor of physical therapy and doctor of nursing practice students, with reported change in the value of interprofessional collaboration increasing from 16.7 percent to 41.7 percent. Students indicated that, “A true concept of team was attained with this project.” Another student stated, “I have a better understanding of how nurse practitioners can work together with physical therapists in a rural setting.”
Value of services at lower costs Cost–benefit analyses of telehealth, electronic health records, physical therapy services, and other health technologies were provided, and project management plans created. The interprofessional teams determined how they would measure possible changes in patient care and assess aggregate population health outcomes. Individual student perceptions were examined to determine the value attained from participation in the interprofessional team and future accountability within each professional’s practice. Student ratings indicated that their knowledge of interprofessional practice increased from a mean of 2.4 to 3.9 on a 5-point scale. Tiny Town, Texas, provided a framework for facilitating interprofessional teams of students to determine how to measure population health outcomes, select technological strategies for improvement of care, and perform cost/benefit analyses.
Better patient care with interprofessional collaboration The second assessment within the framework of an interprofessional class focused on technology-enhanced health promotion and telemedicine. This case is the true story of a severely injured fireman’s rehabilitation from lengthy hospitalization through attainment of his personal goal to successfully complete an Iron Man competition. Interprofessional teams of students (physical therapy, nursing, health science management, occupational therapy, and
nutrition science) assessed and analyzed the patient’s environment. Students applied current technologies and created plans of care, which included selection of the best technological infrastructure to facilitate optimal recovery from injury. At the end of this course, evaluations assess how the students perceive these experiences will affect their future practice. Peer assessment is addressed as faculty members review the student evaluations separately and then again collectively to analyze student understanding of interprofessional collaboration, including implications for curriculum revision.
Preparing learners, faculty, and practitioners with a “new professionalism” Another educational strategy provided students with accelerometer/pedometer devices. Students and faculty documented their own and patient perceptions of these devices. Peer student teams have participated in assessing consumer health care technologies in order to determine which types of applications and education are preferred among the patient populations. Results from faculty and doctoral student research projects will be presented. The “new professionalism” was expressed by one student as, “The courses helped me improve communication with other health care professionals, save time and effort, and improve quality of care. I will really try to create more efficient treatment sessions.” Trust building was addressed by one student as, “I know who to contact to ask how to make systems run more smoothly. I can help patients trust the system and use technology to improve their own health.” The student and faculty practitioners who participate in TWU Health Informatics as a Bridge to the Underserved: Primary Care Strategy exemplify the new professionalism through the skills, understanding, and accountability attained in working as part of interdisciplinary teams solving real-life patient situations.
Susan Schmidt, Ph.D., Judi Godsey, M.S.N., R.N.,
Lisa Niehaus, M.S.N., R.N., and Debra VanKuiken, Ph.D., R.N. Xavier University
Xavier University (XU) launched an IPE program incorporating nine health care professions within the College of Social Sciences, Health, and Education (CSSHE) in Fall 2012. Professional programs included nursing,
athletic training, radiation technology, occupational therapy, health service administration, mental health counseling, special education, doctorate of psychology, and social work. Faculty assessed best practices for preparing undergraduate and graduate students who would be effectively trained upon graduation to collaborate with other professions to improve population health outcomes. Teaching and learning experiences were designed using a technology-rich environment that promotes the development of competent, interprofessional, health care leaders. A comprehensive program of study guided by the four core interprofessional collaboration domains and 38 related competencies outlined by the Interprofessional Education Collaborative (IPEC) was developed (IPEC Expert Panel et al., 2011). The program includes a required 1-credit-hour clinical course, Applied Interprofessional Collaboration. This Web-enhanced course uses clinical simulations, Blackboard discussion groups/exercises, case studies, and panel presentations that require students to actively apply the principles of interprofessional collaboration. Eighty-three graduate and undergraduate students and 16 faculty from 9 professional programs took part in the new Applied Interprofessional Collaboration course. A variety of professional programs and degree levels was chosen because it mimics the backgrounds and educational preparation of the health professions workforce. Assessment of the learning activities requiring active student collaboration (simulations and case studies) were found to produce “thoughtful learning.” This pedagogy was effective for teaching the significant roles and contributions of the health care team in the provision of safe health care delivery. Student evaluations included comments, such as “working with an interprofessional team was very helpful to get many different perspectives” and “I enjoyed the collaboration with individuals from other fields (provided insight).” Students’ evaluations of their team’s effectiveness (using the TeamSTEPPS Team Performance Observation Tool) revealed high ratings in the areas of team structure, leadership, communication, situation monitoring, and mutual support following simulation exercises.
Faculty development included sending nine faculty members to TeamSTEPPS training. These master trainers subsequently trained 19 additional CSSHE faculty, resulting in a total of 28 faculty from 9 programs certified as master TeamSTEPPS trainers prepared to lead IPE at XU. It is believed this next generation of health care providers will deliver coordinated patient care resulting in improved health outcomes at lower cost. Plans are to continue this program and to conduct longitudinal evaluations of graduates regarding their experiences with interprofessional collaboration and the effect of the IPE program at XU following degree completion and employment.
C.13
EVALUATING THE CIHLC COLLABORATIVE LEADERSHIP EDUCATION PROGRAM
Marla Steinberg, M.P.H., Lesley Bainbridge, M.Ed., Ph.D., Maura Macphee, Ph.D., R.N., and Chris Lovato, M.A., Ph.D. University of British Columbia
Sarita Verma, L.L.B., M.B., Maria Tassone, M.Sc., and Benita Tam, Ph.D. University of Toronto
Sue Berry, DipPT, M.C.E., and David Marsh, M.D. Northern Ontario School of Medicine
Rosemary Brander, Ph.D., and Margo Paterson, M.Sc., Ph.D. Queen’s University
Emmanuelle Careau, Ph.D. Université Laval
The Canadian Interprofessional Health Leadership Collaborative (CIHLC) was chosen as one of the four university collaboratives selected by the IOM Board on Global Health to develop leadership programs based on the recommendations of the Lancet commission report on health professional education. The CIHLC is developing a globally adaptable, evidence-based collaborative leadership program through which emerging leaders will develop the capacity for system transformation for context-adaptable, community-engaged, socially accountable improvements in health. The first pilot offering of the program is anticipated in 2014.
The program is based on a systematic review of scientific and gray literature on the concept of collaborative leadership for health systems change, a review of educational programs for the development of collaborative leaders in health care, interviews with key thought leaders in the health and education fields, and an environmental scan of existing programs for the development of collaborative leaders. This review enabled the CIHLC to identify the practices that are required for the collaborative leader of the future. Blended and service learning, principles of enactment, leadership competencies, and ongoing evaluation are critical elements of the program. The program is grounded in the principles of social accountability and community engagement and is embedded in a context of interprofessional and relationship-centered care. This poster provides an overview of how the program will be evaluated.
Using principles of developmental evaluation and the Kirkpatrick framework for the evaluation of professional education, the evaluation of the pilot will provide information on the quality, relevance, and utility of the program and its impact on learners, communities, and health systems.
Mixed methods will be used to ensure that multiple lines of evidence from key stakeholders are brought forward to improve the program, demonstrate how it adds value, and inform future directions. These methods will include evaluation coach check-ins, postmodule surveys (learners and faculty), post-intersession focus groups (learners and mentors), postprogram interviews, Web analytics, reflective journaling, a community engagement survey, and sponsor interviews. The overall evaluation focus will be on quality, relevance, and usefulness; the progress of the action project; the effectiveness of the education program; and the successes, lessons learned, and future directions of the CIHLC Collaborative Health Leadership Program.
The knowledge acquired through the evaluation and other knowledge development work is expected to contribute to the evolving conceptualizations of collaborative leadership, inform pedagogical practices for transformational learning, and provide tools to determine the effect of professional education and collaborative leadership on individuals, communities, and health systems.
Joseph A. Zorek, Pharm.D. University of Wisconsin-Madison; Texas Tech University Health Sciences Center at time of study
David S. Fike, Ph.D. University of the Incarnate Word
Anitra A. MacLaughlin, Pharm.D. Texas Tech University Health Sciences Center; Hereford Pharmacy LLC
Mohammed Samiuddin, M.D., Rodney B. Young, M.D., and Eric J. MacLaughlin, Pharm.D.
Texas Tech University Health Sciences Center
Background The IOM published its first report in 1972, which focused on leveraging teamwork to improve health care delivery (IOM, 1972). Contemporary IOM reports have continued promoting team-based health care delivery as the future of health professional education and as a potential answer to looming health care delivery and affordability problems (IOM, 2003, 2008). While these government-sponsored reports raised the stature of IPE, passage of the Patient Protection and Affordable Care Act, which included provisions for IPE, served to cement its importance in place (U.S. Congress, 2010).
While health care reform was being debated, the professional associations representing American colleges and schools of dentistry, medicine, nursing, pharmacy, and public health formed IPEC. IPEC’s expert panel report, published in 2011, has been widely adopted by educators as a framework for IPE initiatives (IPEC Expert Panel et al., 2011). Simultaneously, select accrediting bodies have begun incorporating robust IPE language into their standards (Zorek and Raehl, 2013). The Liaison Committee for Medical Education, for example, created a new IPE standard that took effect on July 1, 2013 (Liaison Committee for Medical Education, 2012).
This confluence of governmental, professional, and regulatory interest in IPE raises important challenges for educators within the health professions. Now that the need for IPE has been clearly established and accrediting bodies are beginning to demand accountability from their constituents, educators face the challenge of assessing IPE initiatives to demonstrate compliance. In 2012, the Accreditation Council for Pharmacy Education held an invitational conference that focused on, among other topics, IPE and assessment (Zellmer et al., 2013b). Conference presenters and attendees highlighted the dearth of valid and reliable IPE assessment tools, as well as the need for the academy to focus on their creation (Zellmer et al., 2013a). The Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education (SPICE) instrument was created in an effort to address this important need (Fike et al., 2013).
Methods Faculty members from the Texas Tech University Health Sciences Center Schools of Medicine and Pharmacy generated a pool of 20 items for the SPICE instrument, envisioning a three-factor (i.e., subscale) structure using a 5-point Likert-type response scale (1 = strongly disagree, 5 = strongly agree). Fifteen of the items were original, and five items were grounded in the Scale of Attitudes Toward Physician-Pharmacist Collaboration (SATP2C) (Van Winkle et al., 2011). A sample of 179 medical and pharmacy students completed the instrument. One hundred thirty-three students completed the instrument on a one-time basis. To evaluate the instrument’s sensitivity to change, the remaining 46 students were recruited to participate in an interprofessional collaborative practice clinic and were administered the instrument before and after participation. Psychometric properties of the 20-item instrument, including reliability and construct validity, were assessed using confirmatory factor analysis (CFA). The CFA process entailed a priori model specification and evaluated the model based on a variety of statistical indices, including chi-square (Χ2, desired value [dv] p >.05), ratio of chi-square to degrees of freedom (Χ2/df, dv <2), comparative fit index (CFI, dv >.95), and root mean square error of approximation (RMSEA, dv <.06). Parameter estimates including correlation coefficients (dv <.85) and regression weights (dv >.7) were calculated to
determine the relationships of variables within the model. Cronbach’s alpha (dv >.7) and composite reliabilities (dv >.6) were calculated to determine instrument reliability.
Initial CFA models based on the 20-item instrument revealed limitations, leading to development of a refined 10-item, three-factor instrument (see Table C-1). The three factors making up the revised structure included Interprofessional Teamwork and Team-Based Practice (Table C-1: items 1, 5, 6, 8, 9, and 10), Roles/Responsibilities for Collaborative Practice (items 2 and 7), and Patient Outcomes from Collaborative Practice (items 3 and 4). Confirmatory factor analysis of the revised instrument was completed.
TABLE C-1 The Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education (SPICE) Instrument
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| 1 | Working with another discipline of students enhances my education. |
| 2 | My role within the interdisciplinary team is clearly defined. |
| 3 | Health outcomes are improved when patients are treated by a team of professionals from different disciplines. |
| 4 | Patient satisfaction is improved when patients are treated by a team of professionals from different disciplines. |
| 5 | Participating in educational experiences with another discipline of students enhances my future ability to work on an interdisciplinary team. |
| 6 | All health professions students should be educated to establish collaborative relationships with members from other disciplines. |
| 7 | I understand the roles of other professionals within the interdisciplinary team. |
| 8 | Clinical rotations are the ideal place within their respective curricula for medical and pharmacy students to interact. |
| 9 | Physicians and pharmacists should collaborate in teams. |
| 10 | During their education, medical and pharmacy students should be involved in teamwork in order to understand their respective roles. |
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NOTE: Responses based on a five-point Likert-type scale (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree).
Composite reliabilities for the Teamwork and Patient Outcomes factors were .851 and .726, respectively. The composite reliability for the Roles/Responsibilities factor was .582, which was marginally below the recommended standard. Administration of the instrument to students before and after the IPE experience demonstrated significant gains in perception scores on all three factors (Teamwork, p = .003; Roles/Responsibilities, p < .001; Patient Outcomes, p < .001).
Results The sample included broad representation by academic discipline (55 percent medicine, 45 percent pharmacy), year in academic program (54 percent third year, 46 percent fourth year), and gender (45 percent female, 55 percent male). The 10-item, three-factor model demonstrated excellent goodness-of-fit characteristics as evidenced by Χ2 (p = .183), Χ2/df (1.22), CFI (.987), and RMSEA (.036). Factor correlations were acceptable, ranging from .31 to .73, providing support for discriminant validity. The majority of regression weights for the 10 items were favorable. Cronbach’s alpha for the 10-item instrument was .837, demonstrating good reliability.
Conclusions This study detailed the development and validation of the SPICE instrument, a novel tool intended to assess the impact of IPE experiences on medical and pharmacy students. The SPICE instrument consists of 10 items and three factors devoted to interprofessional teamwork and team-based practice, roles/responsibilities for collaborative practice, and patient outcomes from collaborative practice. This study provided evidence of the soundness of the SPICE instrument’s psychometric properties, as well as its sensitivity to change. It may be useful to educational researchers and administrators in assessing the impact of IPE experiences on medical and pharmacy students. Future studies are required to demonstrate the external validity and reliability of the SPICE instrument. Finally, refinements to the instrument, such as the addition of new items to the two factors composed of only two items and elimination of profession-specific language may improve its psychometric properties and broaden its applicability to all health professions.
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