Ruth Margalit

From professional silos to interprofessional education: campuswide focus on quality of care.

Objectives The Institute of Medicine called for the integration of interprofessional education (IPE) into health professions curricula, in order to improve health care quality. In response, we developed, implemented, and evaluated a campus wide IPE program, shifting from traditional educational silos to greater collaboration. Methods Students (155) and faculty (30) from 6 academic programs (nursing, medicine, public health, allied health, dentistry, and pharmacy) engaged with a university hospital partner to deliver this program. The content addressed principles of IPE, teamwork development and 2 common quality care problems: hospital-acquired infections and communication errors. Pre-/post-surveys, the Readiness for Interprofessional Learning Scale, and the Interprofessional Education Perception Scale, were used for descriptive assessment of student learning. Results Students demonstrated increased understanding of health care quality and interprofessional teamwork principles and reported positive attitudes toward shared learning. While responses to the Readiness for Interprofessional Learning Scale grew more positive after the program, scores on the Interprofessional Education Perception Scale were more homogeneous. Both students and faculty highly evaluated the experience. Conclusion This program was a first step in preparing individuals for collaborative learning, fostering awareness and enthusiasm for IPE among students and faculty, and demonstrating the feasibility of overcoming common barriers to IPE such as schedule coordination and faculty buy-in.

Teaching complementary medicine at an academic oncology department

Background. The increased use of complementary and alternative medicine (CAM) by patients with cancer is a significant phenomenon in cancer care and suggests the need for increased knowledge by clinicians of these therapies. Methods. Aiming at bridging the gap in knowledge of the philosophy and practice of major CAM modalities in cancer care, an elective course was offered to physicians and nurses in a large academic center. Results. The course also aimed at providing the tools necessary to establish open and trusting clinician-patient dialogue regarding CAM. Conclusions. Exposure to the course was successful in improving knowledge and attitudes.

Voluntary STD Testing and Treatment Program at a Metropolitan Correctional Facility: Evaluation of Test Acceptability and Associated Risk Factors

Few studies have addressed challenges of diagnosis and treatment of sexually transmitted diseases (STDs) within correctional facilities. Initiatives that screen all inmates can be cost-prohibitive, while symptom-based screening undoubtedly fails to recognize significant numbers of asymptomatically infected persons. This study discusses a voluntary STD screening and treatment program developed at the Douglas County (Nebraska) Department of Corrections where student volunteers interviewed, screened, and educated 456 inmates. Inmate urine samples and interview responses about risk behaviors and motivators for participation in the screening program were analyzed. The results support the ongoing project method to screen and treat inmates in the community correctional facility. Risk factor analysis suggests that targeted testing and treatment efforts may have a role in providing cost-effective care for STD among the incarcerated population.

Comparison of Opt-In Versus Opt-Out Testing for Sexually Transmitted Infections Among Inmates in a County Jail.

A majority of jails in the United States rely on an opt-in (voluntary) rather than opt-out (universal) approach to testing for sexually transmitted infections (STIs). This study compares an opt-out approach at intake to opt-in testing during incarceration and estimates the prevalence of common STIs among jail inmates. Data derive from a universal intake pilot testing program (n = 298) and an established, student-led voluntary testing program (n = 1,963), respectively. The adjusted prevalence as well as the odds of testing positive for chlamydia were significantly higher in the opt-out program (p = .025 and .008, respectively) than the opt-in program but not for gonorrhea (p = .402 and .300, respectively). These results demonstrate the potential public health benefit of implementation of universal STI testing of jail inmates.

Advancing Interprofessional Education: A Qualitative Analysis of Student and Faculty Reflections

Interprofessional education (IPE) is imperative when training health professions students to practice in an environment requiring a team based approach. IPE has not been widely practiced in the United States (US) since its immergence in the 1970’s and waning in the 1980’s.Contemporary curricula, instruction, and IPE activities still need to be tested. This report focuses on the analysis of qualitative feedback collected from faculty and students participating in IPE activities, designed for first year health professions students in the Fall 2010 (n=542), and Fall 2011 (n=555). An interprofessional research team conducted analysis using an immersion/crystallization framework. Eight major themes emerged from comments provided through evaluations of the IPE activities. Students expressed a desire to learn more about roles, skills, and responsibilities of other professions and wanted additional IPE opportunities integrated throughout their education. Skill level of small IPE group facilitators emerged as an important component for successful IPE activities. Lessons learned through this analysis will guide future augmentation of interprofessional activities locally and can be applied at other medical campuses.

Mental health problems due to community violence exposure in a small urban setting

Objective Studies conducted in large metropolitan inner-city communities with high violent crime rates have demonstrated an association between exposure to violence and mental health problems; therefore the purpose of this study was to determine if similar trends exist in smaller inner-city communities with substantially lower violent crime rates. Methods One hundred twenty-six children and young adults living in inner-city Omaha, Nebraska, were screened for posttraumatic stress disorder (PTSD), depression, and anxiety symptoms and assessed for community violence exposure (CVE). Pearson’s correlation and analysis of variance were used to determine the relationship between PTSD, depression, and anxiety symptoms and CVE. Results A statistically significant relationship was found between CVE and PTSD and anxiety symptoms among participants despite their having lower rates of exposure to violent events in comparison with other studies. No association was found between violence and depression symptoms. Additionally, the presence of anxiety and depression, as well as increased age of participants, was associated with higher rates of PTSD symptoms. Conclusion We recommend that health care providers in smaller cities, where the effects of violent crime may be underestimated or overlooked, be informed of the existence of this public health problem within their community and that they screen at-risk patients for mental health problems.