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Creation of an Interprofessional Clinical Experience for Healthcare Professions Trainees in a Nursing Home Setting

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Creation of an Interprofessional Clinical Experience for Healthcare Professions Trainees in a Nursing Home Setting

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Successful interprofessional teams are essential when caring for older adults with multiple complex medical conditions that require ongoing management from a variety of disciplines across healthcare settings. To successfully integrate interprofessional education into the healthcare professions curriculum, the most effective learning experiences should utilize adult learning principles, reflect real-life practice, and allow for interaction among trainees representing a variety of health professions. Interprofessional clinical experiences are essential to prepare future healthcare professionals to provide quality patient care and understand the best methods for utilizing members of the healthcare team to provide that care. To meet this need, the University of Alabama at Birmingham Geriatric Education Center has developed an Interprofessional Clinical Experience (ICE) to expose future healthcare providers to an applied training experience with older adults in the nursing home setting. This paper outlines how this program was developed, methods used for program evaluation, and how the outcome data influenced program revisions.
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2013
2013; 35: 544–548
HOW WE...
Creation of an Interprofessional Clinical
Experience for Healthcare Professions Trainees
in a Nursing Home Setting
CHANNING R. FORD, KATHLEEN T. FOLEY, CHRISTINE S. RITCHIE, KENDRA SHEPPARD,
PATRICIA SAWYER, MARK SWANSON, CAROLINE N. HARADA & CYNTHIA J. BROWN
University of Alabama at Birmingham, USA ‘‘Birmingham/Atlanta VA GRECC’’
Abstract
Successful interprofessional teams are essential when caring for older adults with multiple complex medical conditions that
require ongoing management from a variety of disciplines across healthcare settings. To successfully integrate interprofessional
education into the healthcare professions curriculum, the most effective learning experiences should utilize adult learning
principles, reflect real-life practice, and allow for interaction among trainees representing a variety of health professions.
Interprofessional clinical experiences are essential to prepare future healthcare professionals to provide quality patient care and
understand the best methods for utilizing members of the healthcare team to provide that care. To meet this need, the
University of Alabama at Birmingham Geriatric Education Center has developed an Interprofessional Clinical Experience (ICE)
to expose future healthcare providers to an applied training experience with older adults in the nursing home setting. This
paper outlines how this program was developed, methods used for program evaluation, and how the outcome data influenced
program revisions.
Introduction
Interprofessional team-based care is provided by an intention-
ally created group of healthcare professionals who share a
common goal, to deliver effective and efficient healthcare to
their patients with complex medical and social vulnerabilities
(Geriatrics Interdisciplinary Advisory Group 2006; IPEC 2011;
Partnership for Health and Aging 2011). A successful
interprofessional team can lower overall healthcare costs as
they are less likely to make mistakes during transitions of care
which can reduce and prevent adverse events during dis-
charge (Coleman 2003). They are comprised of members
with specialized knowledge and skills who are active decision-
makers; recognize and appreciate the contributions of others;
and assume responsibility for their decisions and those of the
team (Xyrichis & Lowton 2008; Priegel & Kupperschmidt
2009).
To ensure that future healthcare providers maintain best
practices, it is increasingly important for trainees to experience
interprofessional team-based care (Hammick et al. 2009).
To experience interprofessional education (IPE), trainees must
collaborate with two or more professions and must understand
their role and the roles of the healthcare team (Hallin et al.
2009). Healthcare professional training programs are identify-
ing IPE as a core competence in response to the increasing
fragmentation and complexity of the healthcare system. For
successful interprofessional collaboration to occur, IPE, role
awareness, interpersonal relationship skills, deliberate action,
and support must be considered (Petri 2010).
IPE is most effective when principles of adult learning are
used, learning methods reflect real-life practice experience,
and interaction occurs between trainees (WHO 2010).
Soloman and Risdon (2011) acknowledged that with the
aging demographic, increase in chronic diseases, and shift to
community-based care, providing training opportunities
beyond the hospital, clinic and office settings is a necessity.
Thus, training programs must integrate new experiences into
their curricula to prepare future healthcare providers to
participate in team-based patient care (Committee on the
Future Health Care Workforce for Older Americans 2008).
As the number of graduates of clinical geriatric healthcare
programs working in skilled nursing facilities increases,
training in this environment is essential to prepare them for
this work (Mezey et al. 2009). The nursing home is an ideal
training site for IPE as it allows trainees to work with complex
patients (Johnson 2010; Kanter 2012). To meet this need, we
Practice points
. Effectiveness of interprofessional teams
. Need for interprofessional training for future healthcare
providers
. Nursing home as an ideal setting to train providers about
the complex care of older adults
. Importance of applied training experiences for inter-
professional teams
Correspondence: Channing R. Ford, UAB Geriatric Education Center, CH19-201, 1720 2nd Ave S., Birmingham, AL 35294-2041, USA. Tel: 205-934-
7916; fax: 205-934-7354; email: chann@uab.edu
544 ISSN 0142–159X print/ISSN 1466–187X online/13/070544–5 ß 2013 Informa UK Ltd.
DOI: 10.3109/0142159X.2013.787138
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developed an Interprofessional Clinical Experience (ICE) at a
continuing care retirement community facility to expose
trainees in our university’s healthcare professions to the
complex issues of aging as well as interprofessional team-
based care. This paper will discuss the development, imple-
mentation, and challenges of developing this experience. It
will also describe our strategies for program evaluation and
for overcoming the challenges we faced.
How we started
Program overview
The University of Alabama at Birmingham Geriatric Education
Center developed ICE to expose healthcare trainees to the
nursing home as a setting of care and to the concept of
interprofessional team-based care. Trainees receive a multi-
level learning experience that begins with an initial interview
of an older adult, progresses to collaboration with healthcare
professional trainees from other disciplines, and culminates in
the development of a comprehensive care plan. The training is
led by a board-certified geriatrician and allows trainees the
opportunity to work in conjunction with other team members
to gain a better understanding of their roles within the team.
This experience also introduces basic principles of geriatrics
and provides insight into systems issues that affect nursing
home care.
Curriculum development
The development of ICE was a multi-step process that
included the following: (1) formation of a planning committee
representing interested disciplines; (2) identification of needs;
(3) program development; (4) implementation; and (5) pro-
gram evaluation and follow-up.
Planning committee
We began by forming a small planning committee to develop
the ICE curriculum. To ensure that an interprofessional
experience was created, faculty were identified from the
following healthcare professions: dentistry, medicine, nutrition
and occupational therapy. These faculty agreed to serve on
the planning committee and to assist with implementation.
This collaboration was essential to the success of this program.
The initial planning meeting focused on discipline-specific
presentations from faculty outlining the level of geriatrics
content and interprofessional team-based training included
within their curriculum. We determined that most programs
provided a lecture-based overview of the types of healthcare
teams and discipline-specific care plan processes. In addition,
all trainees participated in a formal, one time, university-wide
interdisciplinary team training experience. Through these
discussions, it became clear that trainees had minimal
opportunities for interprofessional interactions.
Clinical site
Our relationship with a local continuing care retirement
community provided the ideal rotation site. The facility
provides care for 300 older adults, many of whom have
complex problems that benefit from an interprofessional
management approach. Patients live in independent housing,
assisted living, skilled nursing or specialty care units. This
facility is located close to campus and has a long-established
formal education agreement with our School of Medicine
and Dentistry and the Departments of Occupational Therapy
and Nutrition Sciences as a clinical rotation site. However, our
previously established educational agreements with the facility
exposed our trainees to unidisciplinary training.
Following the initial planning meeting, faculty from the
Departments of Social Work, Optometry, and the School of
Nursing approached us regarding trainee participation in ICE.
Prior to their participation, these faculty had to: (1) establish a
teaching agreement with the facility; (2) integrate ICE into their
discipline’s curriculum; and (3) select a feasible time for their
trainees’ interviews.
ICE preceptors
The ICE preceptor, a Geriatric Medicine faculty member, was
responsible for identifying an older adult to serve as the patient
for each weekly experience and for leading the weekly onsite
team meeting. Before participation, faculty preceptors from
each discipline were responsible for orienting and coordinat-
ing the experience for their respective trainees. Discipline
preceptors used varying orientation methods to communicate
experience details to their trainees, with email communica-
tions being the most effective. In addition to the described
experience, some discipline preceptors required their trainees
to complete additional assignments (i.e. reflection papers,
discipline-specific intervention plans).
Patient selection
In the week prior to the ICE team meeting, the ICE preceptor
selected a patient based on referrals from other retirement
community physicians or chart reviews. Once selected, the
patient gave their verbal consent to participate in the program.
Patients with communication difficulties due to severe demen-
tia or aphasia, requiring frequent physician visits, or who were
unable to consent were excluded from participation. The ICE
preceptor notified the discipline preceptors with the name and
location of the patient. To ensure compliance with the Health
Information Protection and Portability Act (HIPPA), all patient
information was relayed through a SharePoint site located on a
secure server.
Discipline-specific interviews
Before the team meeting, trainees were required to complete a
discipline-specific interview with the assigned patient and
prepare the interview results (Table 1). The individual
discipline-specific interviews lasted no more than 20 minutes
and questions were based on discipline-specific practice
Interprofessional clinical experience
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standards, reflecting the complex care issues of older adults
(i.e. medical, functional, psychosocial and social).
ICE care plan meeting
The ICE preceptor began the team meeting with a program
overview that outlined the objectives of the experience.
Trainees introduced themselves and provided a brief descrip-
tion of their profession. The ICE preceptor then led the case
discussion. Trainees contributed information gathered from
their interviews and prioritized issues that needed to be
addressed as a team. The discussion included identifying
the goals of the patient, generating a problem list, and
developing a care plan. Following the training session, the
interprofessional care plan was relayed to the patient’s
healthcare team.
Program evaluation
To develop an evaluation for this experience, the committee
explored the use of a six-level model for evaluating IPE
programs in healthcare (Freeth et al. 2002). The model
includes: (1) reactions to the experience; (2a) revision of
attitudes/perceptions in response to the training; (2b) acqui-
sition of knowledge/skills; (3) behavioral change; (4a) change
in organizational practice; and (4b) benefits to patients/clients
(Freeth et al. 2002). For ICE, the committee focused on
evaluating the experience at levels 1 and 2a.
Prior to and following the experience, each trainee elec-
tronically completed the 14-item UCLA Geriatrics Attitudes
Scale (Reuben et al. 1998). This validated instrument asks
trainees to indicate the degree to which they agree or disagree
with statements about older adult healthcare on a 5-point
Likert scale. Trainees also completed a post-experience
assessment to evaluate the perceived value of interprofessional
teams, team roles, and inter-team member communication
as well as patient communication. Designed specifically
for ICE, this instrument was created by the planning commit-
tee based on the core competencies outlined within the
Core Competencies for Interprofessional Collaborative
Practice (IPEC 2011). No psychometric testing was conducted
on the instrument. Some healthcare disciplines required their
trainees to complete the post-assessment survey to receive
credit for the experience. However, trainees were graded only
on their completion of the assignment and not on their
responses.
Results
In the pilot year, 193 trainees participated in ICE with the
majority reporting positive overall experiences. The response
rate for the overall experience evaluation was 88%. Of the 170
trainees that responded: 41% Dentistry (3rd and 4th years);
13% Optometry (4th year); 13% Nursing (4th year); 12%
Internal Medicine (interns); 11% Occupational Therapy
(2nd year); 8% Social Work (undergraduate); and 3%
Dietetics (1st year).
The response rate of the post-assessment survey was
slightly lower at 85%. Overall, trainees indicated that the
experience was positive and agreed that interprofessional care
of the complex older adult was cost effective (p¼0.007). They
also agreed that accessing a patient’s health literacy level could
improve the quality of care (p50.001) and that respecting the
dignity and privacy of the patient when discussing the care
plan with the interprofessional team (p¼0.01) was essential.
The response rate for the UCLA Geriatrics Attitudes Scale pre-
test and post-test was 38% and 35%, respectively. The pre/
post-tests were unpaired, which prohibited a valid comparison
of pre and post-experience attitudes. Following the pilot year,
a focus group was conducted to assess the overall program
components. Seven trainees participated from nursing, optom-
etry, and social work. Trainees commented on the benefits of
interacting with an older adult in a unique care setting as well
as learning strategies for collaborating to develop an
Table 1. Sampling of discipline-specific guided questions.
Discipline Questions
Occupational therapy 1. How much help do you need to get ready in the morning—eating, bathing, dressing, grooming? Do you use any equipment?
2. Tell me how you do getting to the toilet or commode—how much help do you need?
Optometry 1. How long has it been since your last eye examination?
2. Have you noticed any recent changes in your vision?
3. Do you use glasses, special magnifiers or low vision devices? Do you use them all the time?
Nursing 1. What kind of health problems are you currently having? Explore their specific problems.
2. What medicines are you currently taking? Do you have trouble remembering what to take and when?
3. Are you having problems with pain? What is being done to control your pain?
Medicine Complete a brief history and physical examination of your patient.
Dentistry 1. Do you have your own teeth? Do you wear dentures? Removable partial dentures?
2. Do you brush your teeth/dentures? How often? When? Do you need help?
3. Do you have mouth sores, bleeding or pain? Are any of your teeth loose or broken?
Nutrition 1. Have you had a weight loss/gain greater than 10 pounds in the last month?
2. If you have lost weight, have you followed a weight loss diet? If yes, how long?
3. Have you had recent changes in appetite? Describe.
Social work 1. Tell me a little bit about yourself. Prompt patient to include basic demographics about living situation, family, and financial resources.
2. Do you feel depressed?
C. R. Ford et al.
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interprofessional care plan. In addition, trainees voiced an
appreciation for and a better understanding of the roles of the
other healthcare team members.
What’s next
Implementation and lessons learned
Throughout the design and initial implementation phases, the
planning committee identified several barriers that potentially
affected program outcomes. These included: (1) delays in
implementation; (2) inconsistency in trainees’ experiences;
and (3) difficulty in determining the day and time for the
weekly team meeting.
The planning committee discovered that while all the
participating disciplines showed a strong commitment to
the experience, there were implementation barriers that had
not been considered. The challenges experienced included:
(1) scheduling the discipline-specific patient interviews;
(2) scheduling the weekly team meeting; (3) inconsistency in
discipline participation; and (4) ineffective program evaluation
measures. Due to pre-established rotations, we struggled to
schedule discipline-specific interviews. This often resulted in
trainees from more than one discipline arriving to interview
the patient at the same time. We also experienced patients
complaining of fatigue due to completing multiple interviews
in succession.
Due to varying academic calendars in the various health
professions schools, trainees were away for breaks, midterms,
and final examinations at different times making the schedul-
ing of team meetings difficult. Additionally, several schools
had no scheduling flexibility regarding trainee participation
because of other curriculum demands. This resulted in erratic
discipline attendance at the weekly team meetings. While
these inconsistencies were difficult to prevent, it emphasized
the importance of each discipline’s participation.
Redefining the experience
Following the completion of the pilot period, the planning
committee reviewed the program objectives and outcomes
data to determine programmatic changes for the following
academic year. Due to the challenges encountered regarding
the patient interview, we determined that a restructuring of
the activity was imperative. To reduce patient burden and to
provide a cohesive experience, the patient interview and the
team meeting were integrated into one session.
We determined that the post-assessment survey was
ineffective and needed to be modified. The purpose of this
instrument was reevaluated and we decided to adopt a second
validated instrument, the Attitudes Toward Interdisciplinary
Health Care Teams assessment (Heinemann et al. 1999).
We also determined that a retrospective pre/post-test would
be utilized to allow us to link and examine changes in attitude.
This evaluation method was utilized as studies have found that
this method is well suited to assess attitude changes (Skeff &
Stratos 1992; Levinson et al. 1990). Tracking information was
added for the new academic year to allow us to assess the pre/
post-assessment and Geriatrics Attitudes survey. This change
was also made to ensure completion of the experience.
However, the experience evaluations continue to remain
anonymous.
Conclusion
ICE has proven to be an innovative and valuable new
experience for educating healthcare professions trainees
about the care of the older adult with complex healthcare
needs using an interprofessional team approach. Trainees who
completed the program gained first-hand knowledge regard-
ing the benefits of the interprofessional team as well as a better
understanding and appreciation of the various disciplines roles
on the healthcare team. ICE trainees also gained experience in
interviewing an older adult and developing successful
strategies for collaborating with members of a healthcare
team to create a comprehensive care plan sensitive to the
unique needs of an individual patient. We feel that ICE
provides a positive training experience and better prepares
trainees to provide collaborative and patient-centered care to
older adults.
Declaration of interest: The authors report no declarations
of interest. Dr Sheppard received effort support for her role as
the preceptor for the Interprofessional Clinical Experience
from the Health Resources and Services Administration funded
Geriatric Education Center grant (UB4HP19045). This work
was supported in part by the John A. Hartford Foundation
Scholar Award from the Southeast Center of Excellence in
Geriatric Medicine.
Notes on contributors
CHANNING R. FORD, MPA, MA, is the Education Program Director for the
Division of Gerontology, Geriatrics and Palliative Care at the University of
Alabama at Birmingham (UAB). She is the Associate Director for Program
Implementation for the UAB Geriatric Education Center (GEC).
KATHLEEN T. FOLEY, PhD, OTR/L, is an Assistant Professor in the School
of Health Professions and the Department of Occupational Therapy at
UAB. She is a previous Faculty Scholar of the UAB GEC and serves as a
member of the core development team for the Interprofessional Clinical
Experience (ICE).
CHRISTINE S. RITCHIE, MD, MSPH, served as the Program Director for the
UAB GEC during the initial development of the Interprofessional Clinical
Experience. As an experienced educator, she provided expertise on
curriculum development and integration.
KENDRA D. SHEPPARD, MD, MPSH, is an Assistant Professor in the
Division of Gerontology, Geriatrics and Palliative Care at UAB. Dr.
Sheppard served as a member of the core development team for ICE and
also serves as the lead ICE preceptor.
PATRICIA SAWYER, PhD, is an Associate Professor in the Division of
Gerontology, Geriatrics and Palliative Care at UAB and serves as the
evaluator for the UAB GEC.
MARK SWANSON, OD, is an Associate Professor in the UAB School of
Optometry and serves as a member of the core development team for ICE.
CAROLINE N. HARADA, MD, is an Assistant Professor in the Division of
Gerontology, Geriatrics and Palliative Care at UAB. She serves as the
Rotation Director for the month-long Geriatrics rotation for first year
residents. Dr. Harada also served as a member of the ICE core development
team.
CYNTHIA J. BROWN, MD, MSPH, serves as the Program Director for the
UAB GEC and an Associate Professor in the Division of Gerontology,
Geriatrics and Palliative Care at UAB. A board certified geriatrician and
Interprofessional clinical experience
547
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former physical therapist, Dr. Brown provides expertise on effective
strategies for working in interprofessional teams.
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... The knowledge about multiprofessional students' experiences from a practice-based IPE orientation in nursing homes for elderly complex patients [15][16][17][18][19] is particularly limited. Nursing homes can create a good learning platform for students to understand all aspects of a patient's health and especially of those with complex care needs [17,19]. ...
... The knowledge about multiprofessional students' experiences from a practice-based IPE orientation in nursing homes for elderly complex patients [15][16][17][18][19] is particularly limited. Nursing homes can create a good learning platform for students to understand all aspects of a patient's health and especially of those with complex care needs [17,19]. Therefore, IPE with elderly complex patients could also be a means by which to foster age-friendly care within the healthcare systems [5]. ...
... Thus, future studies should investigate ideal group size and combination of students to achieve targeted learning outcomes. Our findings are in line with other studies [17,19] also pointing out nursing homes as appropriate arenas for a practice-based IPE activity. These arenas provide an opportunity for students to experience very complex patients' situations during their education. ...
Article
Full-text available
Background An ageing population leads up to increasing multi-morbidity and polypharmacy. This demands a comprehensive and interprofessional approach in meeting patients’ complex needs. This study describes graduate students’ experiences of working practice based in interprofessional teams with complex patients’ care needs in nursing homes. Method Students from advanced geriatric nursing, clinical nutrition, dentistry, medicine and pharmacy at the University of Oslo in Norway were assigned to groups to examine and develop a care plan for a nursing home patient during a course. Focus groups were used, 21 graduate students participating in four groups. Data were collected during spring 2018, were inductively analysed according to a thematic analysis method (Systematic Text Condensation). An analytical framework of co-ordination practices was applied to get an in-depth understanding of the data. Results Three themes were identified: 1) Complex patients as learning opportunities - an eye-opener for future interprofessional collaboration 2) A cobweb of relations, and 3) Structural facilitators for new collective knowledge . Graduate university students experienced interprofessional education (IPE) on complex patients in nursing homes as a comprehensive learning arena. Overall, different co-ordination practices for work organization among the students were identified. Conclusions IPE in nursing homes facilitated the students’ scope from a fragmented approach of the patients towards a relational and collaborative practice that can improve patient care and strengthen understanding of IPE. The study also demonstrated the need for preparatory teamwork training to gain maximum benefit from the experience. Something that can be organized by the education institutions in the form of a stepwise learning module and as an online pre-training course in interprofessional teamwork. Further, focusing on the need for well thought through processes of the activity by the institutions and the timing the practice component in students’ curricula. This could ensure that IPE is experienced more efficient by the students.
... Overall, few studies have applied qualitative or theoretical approaches in addressing effects of interprofessional learning or students' experiences of interprofessional collaboration (IPC) and IPE (11)(12)(13)(14). Especially, there is limited knowledge about multiprofessional students' experiences from IPE in nursing homes for elderly complex patients (14)(15)(16)(17)(18). There are indications that nursing homes can create a good learning platform for students to understand all aspects of a patient's health, and especially of those with complex care needs (16,18). ...
... Especially, there is limited knowledge about multiprofessional students' experiences from IPE in nursing homes for elderly complex patients (14)(15)(16)(17)(18). There are indications that nursing homes can create a good learning platform for students to understand all aspects of a patient's health, and especially of those with complex care needs (16,18). To increase the knowledge about IPE in nursing homes, this study aimed to describe graduate students' experiences of working in interprofessional teams with complex patients' care needs in nursing homes. ...
... This makes in line with other studies (16,18) nursing home is an appropriate arena for an IPE activity because it provide the possibilities for students' to experience complex patients' situations during their education. Even if it was challenging and sometimes frustrating, their possibility to discuss di culties with each other and the faculty enhanced their scope of the patients need and the advantages of collaboration. ...
Preprint
Full-text available
Background An ageing population leads up to increasing multi-morbidity and polypharmacy. This demands a comprehensive and interprofessional approach in meeting patients’ complex needs. This study describe graduate students’ experiences of working in interprofessional teams with complex patients’ care needs in nursing homes. Method Students from advanced geriatric nursing, clinical nutrition, dentistry, medicine and pharmacy at the University of K in Norway were joined to groups to examine and develop a care plan for a nursing home patient during a course. Focus groups were used, where 21 graduate students participated in four groups. Data were collected during spring 2018 and were inductively analysed according to a thematic analysis method (Systematic Text Condensation) and discussed using four previously proposed types of coordination practices. Results Three themes were identified: 1) Complex patients as learning opportunities- an eye-opener for future interprofessional collaboration 2) A cobweb of relations, and 3) Structural facilitators for new collective knowledge. Graduate university students experienced IPE on complex patients in nursing homes as a comprehensive learning arena. Conclusions Interprofessional education in nursing homes disclose challenges and possibilities to develop the health care service for elderly patients with complex care needs. It is important to experience complex situations during professional education, even if frustrating, when students have the possibility to discuss difficulties with each other and the faculty. Educators can arrange their IPE activity to foster more collaborative practices and potentially increase learning outcomes.
... In addition, the common risk factor approach (CRFA) considers common health determinants for preventive measures in a multi-professional collaboration [3]. A number of recent reports have emphasized the importance of integrating the dental and medical professions and involving all health professionals in public oral health care (OHC) [4][5][6][7][8]. Although physicians have shown a willingness to learn about OHC and to provide preventive measures for their patients [5,9], they receive limited training in this field, and medical curricula often include only limited information on OHC [5,7,[10][11][12][13]. ...
... Nobody knew that "Using fluoride toothpaste is more important than the brushing technique for preventing caries" in group A, while 3% in group B and 17% in control group answered correctly to this question. The bacteria that causes dental decay usually transmit from mother to the child 16 (6) 84 (32) 68 (26) 22 (7) 31 (10) 9 (3) 33 (12) 42 (15) 33 (12) Toothpastes which contain fluoride should not be used for children under 3 years old 18 (7) 53 (20) 35 (13) 22 (7) 13 (4) -9 (−3) 17 (6) 17 (6) 17 (6) Teeth cleaning and brushing should be started from 2-to 3-years old, when deciduous dentition is completed 21 (8) 55 (21) 34 (13) 38 (12) 47 (15) 9 (3) 36 (13) 25 (9) 36 (13) Pacifier sucking in under-4-year-old children is a risk factor for dento-alveolar malformation (4) 88 (28) 91 (29) 3 (1) 100 (36) 100 (36) 100 (36) The first signs of decay are white spots or lines on teeth surfaces 47 (18) 97 (37) 50 (19) 47 (15) 63 (20) 16 (5) 44 (16) 39 (14) 44 (16) The frequency of sugar consumption has a greater role in producing caries than does the total amount of sugar consumed 97 (37) 97 (37) 0 (0) 88 (28) (24) 3 (1) 13 (4) 10 (3) 17 (6) 17 (6) 17 (6) The best time to refer a pregnant woman for emergency dental procedure is in second semester 71 (27) 87 (33) 16 (6) 56 (18) 66 (21) 10 (3) 75 (27) 78 (28) 75 (27) The main cause of periodontal diseases is dental plaque 82 (31) 100 (38) 18 (7) 72 (23) 84 (27) Instead, 97% of physicians in group A, 88% in Group B, and 94% in control group knew that "The frequency of sugar consumption has a greater role in producing caries than does the total amount of sugar consumed" and 90% in group A, 88% in Group B, and 100% in control group knew "the reason of adding fluoride to toothpaste". The percentage and frequency of the physicians' correct responses to each knowledge questions in the three domains at the baseline and outcome data collection are shown in Table 1 for the two intervention and control groups. ...
... In addition, the common risk factor approach (CRFA) considers common health determinants for preventive measures in a multi-professional collaboration [3]. A number of recent reports have emphasized the importance of integrating the dental and medical professions and involving all health professionals in public oral health care (OHC) [4][5][6][7][8]. Although physicians have shown a willingness to learn about OHC and to provide preventive measures for their patients [5,9], they receive limited training in this field, and medical curricula often include only limited information on OHC [5,7,[10][11][12][13]. ...
... Nobody knew that "Using fluoride toothpaste is more important than the brushing technique for preventing caries" in group A, while 3% in group B and 17% in control group answered correctly to this question. The bacteria that causes dental decay usually transmit from mother to the child 16 (6) 84 (32) 68 (26) 22 (7) 31 (10) 9 (3) 33 (12) 42 (15) 33 (12) Toothpastes which contain fluoride should not be used for children under 3 years old 18 (7) 53 (20) 35 (13) 22 (7) 13 (4) -9 (−3) 17 (6) 17 (6) 17 (6) Teeth cleaning and brushing should be started from 2-to 3-years old, when deciduous dentition is completed 21 (8) 55 (21) 34 (13) 38 (12) 47 (15) 9 (3) 36 (13) 25 (9) 36 (13) Pacifier sucking in under-4-year-old children is a risk factor for dento-alveolar malformation 3 (1) 42 (16) 39 (18) 6 (2) 9 (3) 3 (1) 14 (5) 17 (6) 14 (5) Using fluoride varnish on under-5-year-olds teeth causes fluorosis and poisoning 26 (10) 66 (25) 40 (15) 31 (10) 34 (11) 3 (1) 33 (12) 33 (12) 33 (12) Sealants are effective in the prevention of pit and fissure caries in newly erupted molars 61 (23) 92 (35) 31 (12) 59 (19) 72 (23) 13 (4) 64 (23) 64 (23) 64 (23) Dental domain ...
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Background Family physicians are in frequent contact with patients, and their contribution to oral health promotion programs could be utilized more effectively. We implemented an oral health care (OHC) educational seminar for physicians and evaluated its impact on their knowledge retention in OHC. Methods We conducted an educational trial for primary care physicians (n = 106) working in Public Health Centers in Tehran city. We launched a self-administered questionnaire about pediatric dentistry, general dental, and dentistry-related medical knowledge and backgrounds. Physicians in intervention group A (n = 38) received an educational intervention (Booklet, Continuous Medical Education (CME), and Pamphlet), and those in group B (n = 32) received only an OHC pamphlet. Group C (n = 36) served as the control. A post-intervention survey followed four months later to measure the difference in the physicians’ knowledge; the Chi-square test, ANOVA and linear regression analysis served for statistical analysis. Results The intervention significantly increased the physicians’ oral health knowledge scores in all three domains and their total knowledge score (p < 0.001). Those physicians who had lower knowledge scores at the baseline showed a higher increase in their post-intervention knowledge. The models showed no associations between the background variables and the knowledge change. Conclusion The primary care physicians’ OHC knowledge improved considerably after an educational seminar with a reminder. These findings suggest that OHC topics should be included in physicians’ CME programs or in their curriculum to promote oral health, especially among non-privileged populations.
... PHPs can help diagnose oral health issues in their early stages and preclude their systemic effects in immunocompromised PC patients if they are given appropriate training in this field. According to studies, these PHPs have a significant impact on preventive activities and are a potential target for educational interventions [21][22][23]. ...
Article
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Objectives: The study aim was to evaluate the empowerment of primary healthcare providers on the prevention and management of dental or oral health issues among postchemotherapy (PC) patients, in selected rural regions, India, during a pandemic. Methods: Initially, 240 PHPs were recruited by convenient and snow ball sampling with 90.3% response rate. A descriptive, cross-sectional study was adopted using a self-administered questionnaire with 5 sections: demographics, identification of dental/oral health issues, knowledge, attitude, and practice on prevention and management of dental/oral health problems in PC patients. Statistical Packages for Social Sciences (SPSS) version 23.0 was used for statistical analysis. Results: The overall knowledge was better among nurses (64.56%), followed by pharmacists (54.5%). 81.65% of PHPs were willing to learn more and expressed the need for collaboration with dentists. In the past 3 months, 18.81% of them had PC patients with dental/oral health issues, but only 3.5% of nurses and 0.8% of pharmacists treated them. The logistic regression model revealed higher scores in mucositis/mucosal pain (OR = 1.41), altered taste sensation (OR = 1.34), sensitive gums (OR = 1.71), and dental caries (OR = 1.32) domains (p < 0.05). Those who had readiness to learn (OR = 5.37), nurses and pharmacists, and having less years of experience (OR = 1.31) and higher degree (OR = 1.4) had a positive attitude (p < 0.05). Conclusion: PHPs had limited empowerment in terms of knowledge and practice but showed a positive attitude toward the prevention and management of dental/oral health issues of PC patients. For better practice, continuing education and collaboration with dental professionals is essential.
... Ford and colleagues created an IP student team experience involving interviewing an older adult patient at a local nursing home. 22 Kent and colleagues had seniorlevel IP student teams complete onetime patient consultations in a residential care facility in Australia. 23 Students had high satisfaction, and Kent's team found the facilities to be useful IP teaching environments. ...
Article
Introduction: Interprofessional (IP) clinical care is ideally taught in authentic environments; however, training programs often lack authentic opportunities for health professions students to practice IP patient care. Skilled nursing facilities (SNFs) can offer such opportunities, particularly for geriatric patient care, but are underutilized as training sites. We present an IP nursing facility rotation (IP-SNF) in which medical, pharmacy, and physical therapy students provided collaborative geriatric patient care. Methods: Our 10-day immersion rotation focused on four geriatric competencies common to all three professions: appropriate/hazardous medications, patient self-care capacity, evaluating and treating falls, and IP collaboration. Activities included conducting medication reviews, quarterly care planning, evaluating functional status/fall risk, and presenting team recommendations at SNF meetings. Facility faculty/staff provided preceptorship and assessed team presentations. Course evaluations included students' pre/post objective-based self-assessment, as well as facility faculty/staff evaluations of interactions with students. Results: Thirty-two students (15 medical, 12 pharmacy, five physical therapy) participated in the first 2 years. Evaluations (n = 31) suggested IP-SNF filled gaps in students' geriatrics and IP education. Pre/post self-assessment showed significant improvement (p < .001) in self-confidence related to course objectives. Faculty/staff indicated students added value to SNF patient care. Challenges included maximizing patient care experiences while allowing adequate team work time. Discussion: IP-SNF showcases the feasibility of, and potential for, engaging learners in real-world IP geriatric patient care in a SNF. Activities and materials must be carefully designed and implemented to engage all levels/types of IP learners and ensure valuable learning experiences.
... R esidential aged care facilities (RACFs), also known as care homes, aged care homes or old people's homes, can provide unique and valuable medical student clinical learning opportunities (clerkships), including in interprofessional practice (IPP), but the literature suggests that this practice is limited to the Netherlands, the USA and Australia. [1][2][3][4] Based on our 8-year experience of delivering a 5-day RACF clerkship to Australian senior medical students, 5 we explain why an RACF clerkship should be considered for all medical programmes, and describe aspects of our RACF medical curriculum, including IPP. ...
... Studies have shown that these auxiliary workers have a considerable impact on preventive activities and are a potential target for educational interventions. [17,19] In the present study, majority of the nurses held positive attitudes toward OHC but felt that the service provided by them may not be efficient and were willing to learn and the same trend is seen in other parts of the word. [11,[13][14] Nurses are interested in obtaining more training in OHC, and thus, the same needs to be added in their curriculum. ...
Article
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Methods: The study was a cross-sectional questionnaire survey. Total of 170 medical nurses working in the Institutional Hospital and who provided care for paediatric patients and pregnant mothers participated in the study. Statistical analysis: Chi-Square test was used to analyse the data using SPSS version 17.0 with a significance value of P < 0.05. Results: All the nurses were aware that good oral health is important for overall health of the child. About 70% of the respondents had poor knowledge regarding dental caries. Good response was obtained regarding importance of oral hygiene maintenance for both the child and mother for prevention of caries. Majority of the nurses showed positive attitudes toward preventive OHC and the role of medical nurses. Routinely the nurses do not refer pregnant mothers and children for dental check up nor do they counsel them regarding oral hygiene and its importance. Conclusion: Appropriate training and encouragement for promotion of oral health and to provide suitable care for the prevention of dental diseases should be included in the curriculum of nurses training.
Article
Context Interprofessional education (IPE) prepares clinicians for collaborative practice, yet little is known about the effectiveness of postgraduate IPE. Objectives This is the first study to describe educational outcomes of an interprofessional fellowship in pediatric palliative care. Objectives were to understand the experiences of postgraduate trainees in an interprofessional, clinical environment and to evaluate program effect on interprofessional competencies. Methods In this mixed-methodology study, we surveyed former fellows from 2002 to 2018 about their fellowship experience and perceived change in interprofessional skills. We performed qualitative semantic content analysis of fellows’ responses about learning in an interprofessional context. We compared fellows’ self-rated ability (5-point Likert scale), before and after fellowship, in 10 interprofessional competencies selected from the Interprofessional Education Collaborative's core competencies. Results Response rate was 87% (41/47). 51% of respondents were physicians, 29% were social workers, and 20% were nurse practitioners. Respondents reported significant improvement in all 10 competencies, with summed mean scores of 2.8±0.6 pre-fellowship (“not very well prepared”) and 4.4±0.4 post-fellowship (“very well” to “extremely well prepared”) (t =15.6, p<.0001). Effect size for each competency was greater than 1.9 (strong positive impact). The fellowship experience was characterized by dynamic educational relationships: peer relationships with interprofessional co-fellows, mentoring relationships with faculty, clinical relationships with patients and families, and collaborative relationships with the healthcare system. Benefits and challenges of IPE were associated with interprofessional roles, teamwork, patient care, and educational needs. Conclusion This study demonstrates the feasibility and effectiveness of an interprofessional postgraduate fellowship in preparing clinicians for collaborative practice.
Article
This chapter takes a brief look at this history of health professions education focusing on human medicine, pharmacy, and nursing. This is followed by a description of a model of university teaching and learning to provide a framework for understanding and enhancing healthcare education. Finally, challenges facing today's system for educating health providers are detailed and the chapter concludes by listing suggestions for meeting these challenges.
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The home care setting is ideal for medical students to learn about the importance of interprofessional collaboration in the community. This project examined the impact of a unique program designed to facilitate medical students' knowledge and awareness of the challenges of interprofessional care in the home. In pairs, medical students participated in two community visits with preceptors from different professions. Students completed a structured personal reflection after their first visit. Students and preceptors participated in focus groups or interviews to identify strengths and challenges of the experiences. The structured reflections and the focus group and interview transcripts were analyzed qualitatively. 164 medical students and 36 preceptors participated in 326 visits. There were high ratings of satisfaction from students and preceptors. Students developed unexpected insights into peoples' lives, developed a greater understanding of the patient's perspective and determinants of health, learned about others' scope of practice, and developed an appreciation of the limitations of their own scope of practice. Preceptors had high expectations for student performance and engagement and enjoyed the opportunity to impart their knowledge to future physicians. Although organizationally complex, the program evaluation suggestions that students and preceptors benefit from interprofessional experiences in the home.
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Pre- and postintervention self-assessments are commonly used to evaluate educational interventions. However, when training influences participants'criteria for their self-ratings (response shift), the validity of the traditional prefpost comparisons is suspect. We assessed the influence of this phenomenon in a national faculty development program for clinical teachers. We compared changes in traditional pre/post self-assessment ratings with changes in retrospective pre/post self-assessment ratings. Data included prelpost intervention faculty self-assessments and evaluations of faculty by housestaff and students. On dimensions addressed in the training program, retrospective pre/post comparisons revealed more significant changes in teaching performance and attitudes than traditional pre/post comparisons. Housestaff and student evaluations were more consistent with thefaculty 's retrospective pre/post than with traditional prelpost comparisons. We conclude that, compared to traditional prelpost self-assessment; retrospective pre/post ratings may provide a more sensitive and more valid measure of the effects offaculty development.
Article
Self-assessments are frequently used to evaluate the effectiveness of medical education programs. The change in learners' self-ratings preto post-course is attributed to the educational intervention. However, participants may also change their understanding of the dimension being measured and hence, adjust their criteria for self-rating (response shift). This study was designed to compare a conventional prelpost course evaluation design with a retrospective pre/post method used to minimize the effect of the response shift. Participants attending a course in 1987 or 1988 designed to improve interviewing and teaching skills completed a faculty self-rating form (a) one month before the course; (b) after the course, assessing their pre-course skill level (retrospective pre-course); and (c) after the course, assessing their present skill level (post-course). Retrospective pre-course ratings were significantly lower than actual precourse ratings in two out of four factors empirically derived from the assessment instrument in 1987 and three of four in 1988. Greater differences preto post-course were found using the retrospective as opposed to the actual pre-course self-ratings. Our findings indicate that the collection of retrospective pre-course and post-course self-ratings at a single point in time demonstrates greater differences than the conventional pre/post evaluation method. Use of the retrospective precourse method is efficient and may be a more accurate evaluation method than the conventional prelpost evaluation.
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The study aims to explore the meaning of interdisciplinary collaboration within the context of health care. Rodgers' Evolutionary View of Concept Analysis was employed to identify attributes, antecedents, and consequences of interdisciplinary collaboration. Utilizing an inductive approach, a systematic review of the literature was undertaken in August 2007 to clarify the current use of interdisciplinary collaboration in health care. Interdisciplinary collaboration is commonly described using the terms problem-focused process, sharing, and working together. The elements that must be in place before interdisciplinary collaboration can be successful are interprofessional education, role awareness, interpersonal relationship skills, deliberate action, and support. Consequences of interdisciplinary collaboration are beneficial for the patient, the organization, and the healthcare provider. A comprehensive definition of interdisciplinary collaboration within the context of health care is presented as an outcome of this analysis. It is recommended that further inquiry in this area focus on the development of valid measures to accurately evaluate interdisciplinary collaboration in health care.
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Nationally, 1.5 million persons live in nursing homes,1 many under conditions that we would not want for ourselves or for those we love. William Thomas, MD (developer of the Eden Alternative), articulated 3 common conditions that afflict nursing home residents: boredom, loneliness, and helplessness. Fortunately, there is a growing movement to change the culture of nursing homes so that they are more resident centered.Changing the culture of nursing homes requires a concerted effort to provide stimulating activities and opportunities for spontaneity and meaningful social interactions for residents, while facilitating their sense of worth by caring for pets, gardens, and each other. Cultural change also involves creating a comfortable, homelike setting that is more like a community than a hospital. This includes making the nursing home less institutional and more homelike, with the addition of color, natural light, plants, pets, and home furnishings. However, the biggest change that is needed is to reengineer the resident care planning process to be resident centered and resident directed, which means that the wishes of residents, rather than the dictates of staff, determine activities, choice of meals, and schedules.
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This guide is for health and social care professionals who teach or guide others' learning before and after qualification, in formal courses or the workplace. It clarifies the understanding of interprofessional learning and explores the concept of teams and team working. Illustrated by examples from practice, the practicalities of effective interprofessional learning are described, and the underlying concepts of patient-centred care, excellent communication, development of capacity and clarity of roles that underpin this explored.
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Nursing homes can be ideal clinical teaching and learning environments for acquiring geriatric specialty and interdisciplinary team skills, particularly those regarding assessment, care planning, management, monitoring, and collaborating in an interdisciplinary milieu. Little is known as to how geriatric specialty training programs use nursing homes to meet expected specialty competencies, or the types of clinical experiences in nursing homes required by academic geriatric training programs. This article describes the expectations of 5 clinical health care disciplines (dentistry, medicine, nursing, pharmacy, and social work) and nursing home administration regarding desirable nursing home characteristics that support gaining geriatric competencies. The issues involved in using nursing homes as supportive educational environments in geriatric education are discussed.