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Impact of an interprofessional population health course and clinical immersion experience: Students and practice outcomes
Abstract
The purpose of this paper is to describe the impact of an interprofessional (IP) population health course and accompanying clinical immersion experience. Outcomes related to IP learning, team-based communication, and clinical practice outcomes are discussed. Graduate students in medicine, nursing, pharmacy, public health and social work participated in a blended learning didactic course followed by a clinical immersion experience in primacy care. Students worked in interprofessional teams to complete a needs assessment, and design and implement quality improvement projects with primary care partners. Student assessment included evaluation of teamwork and collaboration and reflective practice. Overall impact of the course was measured by course outcomes, the impact of the quality improvement project at the practice site, and clinical satisfaction working with the student teams. This model demonstrates a clear need to continue to develop educational curricula aimed at building collaborations between health professionals and communities to provide care to populations that is cost effective and quality and outcomes based.
... IPE has been shown to impact the knowledge, skills, and attitudes of students in health professions schools (Lutfiyya, Brandt, Delaney, Pechacek, & Cerra, 2015) as well as impact quality and safety (Reeves, Boet, Zierler, & Kitto, 2015). Literature from the past decade has shared ways to implement IPE learning activities across academic settings (Djukic, Fulmer, Adams, Lee, & Triola, 2012;MacDonnell, Rege, Misto, Dollase, & George, 2012;Zomorodi et al., 2018), didactically in course work (Zomorodi et al., 2017), in clinical environments (Laksov, Boman, Liljedahl, & Björck, 2015), or in both traditional classroom and clinical practice settings (Lutfiyya, Brandt, & Cerra, 2016). In all instances, faculty must carefully consider the planning, implementation and outcome of these IPE experiences (Sunguya, Hinthong, Jimba, & Yasuoka, 2014). ...
... Students were assessed at the beginning and end of their semester using the Assessment of Interprofessional Team Collaboration Scale (AITCS) and were also assigned a reflective paper to capture qualitative data to complement quantitative data. The interprofessional population health management course was designed as a hybrid course that included on-line modules each week and face-to-face meetings about once a month (Zomorodi et al., 2017). Enrolled students completed in-class and online work in interprofessional teams, as assigned by the course instructors to ensure interprofessional cross-pollination by profession. ...
... [19,48] It is claimed that an internship 'allows students to learn new knowledge and skills by being completely immersed and engaged in the prescribed activity', [49] permits students to develop a rich understanding of the practice setting and form stronger working relationships with clinical staff [50] and promotes more effective interprofessional working. [51] Moreover, it is argued such placements can expose learners to new clinical experiences, help them integrate theory and practice, accelerate their learning and facilitate a more effective transition to a Registered Nurse (RN) role. [52][53][54][55] Funding an internship, however, can be problematic [56] and in some healthcare disciplines, such as chiropractic care, necessitates that placement costs are met fully or partially by the student. ...
This paper highlights the importance of effective clinical experiences for pre-registration nursing students and the wealth of published work associated with practice learning, particularly regarding approaches to student supervision during a practicum. It draws attention to frequent calls within nursing literature for longer placements; many of which fail to either identify the perceived benefits of such change or state whether a longer practicum should involve increased practice learning hours or redistribute existing hours over an extended period; key omissions given the resource-intensive nature of providing these educational opportunities. It also highlights a paucity of research regarding the effect of placement duration and intensity on clinical learning and that practicum design is commonly shaped by custom, practice, operational and financial considerations rather than a sound educational rationale. A Critical Realist review of studies associated with two fundamental placement structures, the block, and integrated models, is offered to consider their strengths and limitations. Moreover, work that evaluates initiatives offering students paid employment in caring roles undertaken alongside a pre-registration programme and therefore displaying similarities to the integrated practice learning model are examined. The review concludes that, as yet, there is insufficient empirical evidence to recommend the targeted application of either a block or integrated placement model within any specific part of a pre-registration nursing programme, calls for greater consistency in the language of placement structure and outlines the author's own current work contributing to the extremely limited body of knowledge available regarding this aspect of curriculum design within nurse education.
... There has been an influx of literature over the last decade on ways to implement IPE learning activities in academic environments (Copley et al., 2007;Djukic, Fulmer, Adams, Lee, & Triola, 2012;MacDonnell, Rege, Misto, Dollase, & George, 2012;Zomorodi et al., 2018). This can occur didactically through joint course work (Zomorodi et al., 2017), in clinical learning environments (Laksov, Boman, Liljedahl, & Björck, 2015), or in both traditional classroom and clinical practice settings (Lutfiyya, Brandt, & Cerra, 2016). In all instances, faculty must carefully consider the planning and implementation of IPE experiences so that they are meaningful and appropriate to all learners (El-Awaisi et al., 2016;Haley et al., 2019) while avoiding common implementation barriers identified within the IPE literature (Sunguya, Hinthong, Jimba, & Yasuoka, 2014). ...
The demands for interprofessional education (IPE) are becoming increasingly more explicit among health professions accreditation standards as well as within social work education. The following teaching note describes an interprofessional book discussion related to Paul Kalanithi’s 2016 book, When Breath Becomes Air. The book explores the end of life experience of a young neurosurgical resident unexpectedly diagnosed with terminal cancer. This content allows students to reflect on their mortality while pursuing their educational goals while also addressing clinical concepts related to team-based care, coordination, and personal, familial, and system perspectives of a major health diagnosis. The book is rich with examples for students to engage in interprofessional discussions salient to social work and across disciplines. The following teaching note includes a detailed description for programs wanting to engage in new or increased IPE efforts at their institution. The rationale for why this book was selected, as well as questions to guide discussion, and related social work competencies are included. Further, lessons learned throughout the planning and implementation process, as well as guidance on how this activity could be replicated or adapted for social work and other programs are discussed.
... Training the next generation of social workers to fulfill multiple roles and functions on integrated care teams is supported by considerable efforts to develop rigorous interprofessional course work, enhanced field placements, and service-learning projects (Zerden, Jones, Brigham, Kanfer, & Zomorodi, 2017;Zomorodi, Zerden, Alexander, Nance-Floyd, & Byerley, 2017). Developing standardized competencies to create a shared training plan among social workers in integrated care settings can assist in refining the expanding, evolving role of social work. ...
Great strides have been made in highlighting the strengths of the social work profession as a workforce vital to improving the health and well-being of individuals, families, and communities. Nevertheless, substantially more work is needed to advance education, practice, and research involving social workers’ potential and their contributions to improved care throughout the life course. This special issue offers exemplars of the power of social work in integrated settings with the capacity to address the scope of behavioral health, psychosocial, and physical health care needs. In today’s rapidly evolving heath care context, integrated care represents a promising direction for the future of health services, and may be leveraged to improve population health across the life course. Papers selected for this special issue focused on two themes: (a) defining the expanding roles and functions social workers fulfill in integrated health settings, and (b) identifying organizational and system factors that affect social workers’ delivery of interventions in integrated health models. This special issue further articulates the added-value of social workers on health care teams and the resulting improved outcomes for patients, families, and communities. Through increased evidence, such as the knowledge gained from this special issue, it is our hope that the profession continues to advance the boundary-spanning roles and capabilities of social workers in integrated health settings—both in the hospital and in community-based settings.
... In [51] and [52], the authors created a survey to measure student perceptions and in [9], the authors measured student perceptions and used performance and teamwork skills as criteria. In addition, performance, knowledge, communication, teamwork and critical thinking are the criteria employed in [53] and [54], and in [55], authors focused on knowledge and attitude. Knowledge of Pharmacy students is evaluated in [56] and [57], whereas [58] added skills to the knowledge criterion. ...
This study surveyed the literature on the criteria of student performance in various educational domains in order to establish the coherent taxonomy and figure out the gap on this pivotal research area. The significant search for articles focused on (1) student evaluation, (2) education-related and (3) criteria and domain. The three reliable databases are Web of Science, ScienceDirect and IEEE Xplore. These databases are sufficiently broad to cover education and technical literature. The set comprised 178 articles. The biggest group (170/178) included various evaluation criteria and domains. Most domains (84/170) covered criteria such as performance and skills. Another group (8/178) utilised surveys and reviews to characterise the evaluation criteria for specific specialisations. Since 2012, researchers have investigated the process of student evaluation in several domains. Regardless of class, the challenges that prohibited the full adoption of evaluation criteria were the focus of articles and recommended mitigations. Although research areas on student evaluation differed, the results were evenly pivotal. This review affirms existing research and provides supplemental areas for future work.
Worldwide, more than one billion people live with a disability (World Health Organization. (2011). World report on disability . Retrieved from https://www.who.int/disabilities/world_report/2011/report/en/ ). People with a disability (PWD) have unmet needs with the delivery of health care, secondary to nursing student’s negative attitudes, knowledge, and skill deficits. This integrative literature review evaluated nursing student’s education and attitudes towards PWD. Deficient education, attitudes, knowledge, and skills are addressed. Combined search terms utilized included: healthcare students; healthcare education; nursing students; clinical experience; clinical rotation; attitude of health care students; and exposure to PWD. Thirty articles were analyzed with common themes identified. Educational methods that produced improved attitudes, knowledge and skills included standardized patients with disabilities; phenomenological approaches; curriculum enhancement; empathy exercises and clinical experiences (Anderson, E. S., Ford, J., & Thorpe, L. (2011). Learning to listen: Improving students’ communication with disabled people. Medical Teacher , 33 (1), 44–52. doi: 10.3109/0142159X.2010.498491; Castro, S. S., Rowe, M., Andrade, L. F., & Cyrino, E. G. (2018). Developing competencies among health professions students related to the care of people with disabilities: A pilot study. Interface: Comunicacao, Saude, Educacao , 22 (65), 551–563. doi: 10.1590/1807-57622016.0684; Hensel, D., Malinowski, C., & Watts, P. A. (2015). Implementing a pediatric camp clinical for pre-licensure education. Nursing Education Perspectives , 36 (1), 60–61. doi: 10.5480/12-871.1; Levett-Jones, T., Lapkin, S., Govind, N., Pich, J., Hoffman, K., Jeong, S. Y., . . . Everson, N. (2017). Measuring the impact of a ‘point of view’ disability simulation on nursing students’ empathy using the comprehensive state empathy scale. Nurse Education Today , 59 , 75–81. doi: 10.1016/j.nedt.2017.09.007; Smith, P., Ooms, A., & Marks-Maran, D. (2016). Active involvement of learning disabilities service users in the development and delivery of a teaching session to pre-registration nurses: Students’ perspectives. Nurse Education in Practice , 16 (1), 111–118. doi: 10.1016/j.nepr.2015.09.010). Nursing schools must incorporate disability education to fully realize its impact and eliminate barriers to transform care.
Knowledge was mapped about how usability has been applied in the evaluation of blended learning programs within health professions education. Across 80 studies, usability was explicitly mentioned once but always indirectly evaluated. A conceptual framework was developed, providing a foundation for future instruments to evaluate usability in this context.
Supplementary information:
The online version contains supplementary material available at 10.1007/s40670-021-01295-x.
Many health professionals believe they practice collaboratively. Providing insight into their actual level of collaboration requires a means to assess practice within health settings. This chapter reports on the development, testing, and refinement process for the Assessment of Interprofessional Team Collaboration Scale (AITCS). There is a paucity of literature and measurement tools addressing interprofessional collaborative team performance and the nature of effective teamwork processes and patient roles within collaborative teams. These gaps limit our knowledge about how health care teams form and function. Instruments are therefore needed to assess collaborative relationships.
The AITCS, with its 47 items within 4 subscales (partnership, cooperation, coordination, and shared decision making) and assessed on a 5-point Likert scale, was administered to a total of 125 practitioners from 7 health care teams practicing within a variety of settings, in 2 provinces in Canada.
Principal components and factor analysis of data resulted in 37 items loading onto 3 factors, explaining 61.02% of the variance. The internal consistency estimates for reliability of each subscale ranged from 0.80 to 0.97, with an overall reliability of 0.98. Thus, the AITCS is a reliable and valid instrument.
The psychometric analysis of this instrument supports its value in measuring collaboration within teams and when patients are included as team members. The AITCS can be applied to continuing professional education interventions to determine change over time. It has limitations to the Canadian context and within the settings where participants practiced. Further test and retest reliability and longitudinal study application is needed.
Abraham Flexner's 1910 report is credited with promoting critical reforms in medical education. Because Flexner advocated scientific rigor and standardization in medical education, his report has been perceived to place little emphasis on the importance of public health in clinical education and training. However, a review of the report reveals that Flexner presciently identified at least three public-health-oriented principles that contributed to his arguments for medical education reform: (1) The training, quality, and quantity of physicians should meet the health needs of the public, (2) physicians have societal obligations to prevent disease and promote health, and medical training should include the breadth of knowledge necessary to meet these obligations, and (3) collaborations between the academic medicine and public health communities result in benefits to both parties. In this article, commemorating the Flexner Centenary, the authors review the progress of U.S. and Canadian medical schools in addressing these principles in the context of contemporary societal health needs, provide an update on recent efforts to address what has long been perceived as a deficit in medical education (inadequate grounding of medical students in public health), and provide new recommendations on how to create important linkages between medical education and public health. Contemporary health challenges that require a public health approach in addition to one-on-one clinical skills include containing epidemics of preventable chronic diseases, reforming the health care system to provide equitable high-quality care to populations, and responding to potential disasters in an increasingly interconnected world. The quantitative skills and contextual knowledge that will prepare physicians to address these and other population health problems constitute the basics of public health and should be included throughout the continuum of medical education.
Improving the U.S. health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care. Preconditions for this include the enrollment of an identified population, a commitment to universality for its members, and the existence of an organization (an "integrator") that accepts responsibility for all three aims for that population. The integrator's role includes at least five components: partnership with individuals and families, redesign of primary care, population health management, financial management, and macro system integration.
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