Interprofessional Education
Teaching the concept, Now measuring the results...
Doctors and nurses have worked together for hundreds of years. Study after study has shown that a strong, collaborative healthcare practice team improves patient safety, quality of care and health outcomes, including lower readmission and mortality rates. Conversely, failures in effective collaboration among interprofessional (IP) teams has been associated with increased patient harm, increased hospital lengths of stay, caregiver dissatisfaction turnover and decreased evidence based practice. Yet historically physicians and nurses have been educated and often work in silos, creating barriers to effective collaboration and teamwork.
Based on these studies, in 2009 the UCLA School of Nursing and the David Geffen School of Medicine created a pilot program looking at ways to integrate the two disciplines at UCLA. Nearly a dozen nursing students joined third-year medical students in a class discussing healthcare topics of mutual interest, from legal, economic and ethical issues to team building strategies and differences between medicine and nursing. The idea was to try and get them together in a classroom environment, before they start working together in the clinical setting, so that students from both schools could develop team-building skills, increase their awareness of each other’s roles and get used to working together in making decisions to improve patient outcomes.
The original collaborative class was one quarter and an elective for nursing students. Based on feedback, the class expanded to one year. Today, the course is known as Systems-based Healthcare and is a required course for third-year medical students and acute-care advanced practice nursing students. Because oral health is an essential component of comprehensive healthcare, in 2013, the UCLA School of Dentistry became the first dental school in the country to join an IP education program, by joining the UCLA course.
Once or twice a month, for a total of 15 sessions throughout the year, nursing, medical and dental students meet in small groups to focus on the context of healthcare decision making. Topics are literally “ripped from the headlines,’ and might include the legal, political and moral aspects of sexual assault, the economics and cultural considerations involved in end-of- life decision making, and the public and personal interpretation of what constitutes conflict of interest.
In a recent class, students discussed the topic of boundaries and burnout. During the class, students discussed compassion fatigue, moral distress and how they were related, what might cause burnout in health professionals, the impact of burnout on the patient and how to deal with it or prevent it. At the end, students were given a writing assignment: was there a time when you questioned whether this was the right career path for you, or have you ever found yourself really disliking a patient or you felt working in healthcare was powerfully satisfying rewarding?
Other schools of nursing, medicine and other allied health fields across the country are now creating programs where the students learn and work together. Yet, as IP education continues to expand, it is important to effectively evaluate these programs and measure learner outcomes.
Innovative Tools for Measuring Inter-professional Competencies
Up until now, the only tools for evaluation of IP education were based on student self-reporting with limited development of tools to assess competency. While helpful in program planning, self-reporting tools alone did not provide all the information that the UCLA program leadership wanted to know regarding what has changed in terms of students’ knowledge, skills behaviors, experiences and judgment and create standards for this measurement. “We knew this was a huge gap area and a great opportunity to increase our inter-professional education opportunities with the medical students,” said Mary Ann Shinnick, Ph.D., ACNP-BC, Assistant Professor and Director of Simulation at the School of Nursing.
In 2012, the Josiah Macey Foundation funded a grant to support the development of a set of tools that could then be shared with others. An IP team of investigators from the UCLA School of Nursing and David Geffen School of Medicine set out to create tools for assessing the degree to which individual students have accomplished the competencies and objectives identified by the Inter-professional Education Collaborative (IPEC), an association of schools of various health professions formed to promote and encourage the IP learning experience.
The tools developed as a result of this grant increase the ability of IP education programs to measure student’s accomplishments and provide formative and summative results to individual students. In addition, the outcome results can be used for continuous quality program improvement and program evaluation. Some of the tools have been adapted from other disciplines for use in healthcare and some are new tools.
The framework for the tools used The Miller Pyramid, a model that uses knowledge as its foundation and that determines competency, shows how the learner integrates knowledge and skills and ultimately leads to action.
In developing the IP-OSCE, one of the six tools, acute care APN students were paired with third-year Medical Students in a clinic-based case of a chronic heart failure patient who recently lost his job and insurance coverage. The team was tasked with trouble shooting the patient’s problem of skipping medication doses to make them last. “Using the OSCE allows us to look at whether the nursing and medical students can work together, illuminates challenges and misconceptions and informs the educator in weaknesses of instruction,” said Shinnick.” “The pairs of students overwhelmingly commented on their changes in misconceptions they had about each other and the benefits of the paired training.”
Sharing the Tools
Shinnick and Koniak-Griffin have attended several professional conferences to introduce and provide educators with this compendium of tools. (Part of the grant was to create and disseminate these tools – for free – for everyone’s use). Most recently Koniak-Griffin attended the AACN Doctoral Education Conference and Shinnick the National League of Nursing Conference and the International Simulation in Healthcare Conference, where they shared these tools with attendees.
“People are excited about it, they are hungry for it, they’ve never seen anything like it before,” said Shinnick. “Compendiums were distributed to a wide variety of audiences including Deans of Schools of Nursing and many educators from Schools of Medicine as well as leaders in simulation and professionals from all over the world – China, Sweden, Dubai, Qatar, South Korea, Australia.”
“And what is really a homerun is that we are giving the tools away,” both concurred. “This is one of a kind.”
On request, attendees at these conferences interested in the measurement tools were given a flash drive with all the materials.The tools are also available online at http://nursing.ucla.edu for anyone interested in using the tools to measure the effectiveness of their programs.
“We needed to go beyond measuring just the attitudes of students in a learning program. We needed to know how this translated to actual knowledge and behaviors,” added Koniak-Griffin. “We look forward to hearing how others are using the tools and their results.”
The Long-Term Future of Interprofessional Relationships
The ultimate goal of IP education is that it is the norm, rather than the exception.
“There was so much work done to create these tools and our partners at the David Geffen School of Medicine were so committed to this. One great outcome from this is now we have now built a strong relationship that is fostering other collaborations,” added Shinnick. “For all of us, that is very exciting and we look forward to many more IP collaborations in the future.”