Valentina Brashers

Team‐based learning: a strategy for interprofessional collaboration

mation that was incomplete. Of note, doctors used conversation with other doctors to exchange information and ask questions (i.e. to learn) but used conversations with nurses mostly to collect information, not as a source of learning. The relationship between validity, relevance and work used to describe information utility in the medical literature appears to also explain how doctors determine the utility of patient information in the NICU. Factors that affect workload include how easy it is to get to an information source as well as how the information is organised. The social construct of the NICU also seemed to play a role in doctor communication. Doctors in this study reported communicating with each other for reasons different to those for which they communicate with nurses. Studies of airline crews have demonstrated that rigid social hierarchies within crews contribute to failures in communication. Developing a curriculum that highlights how information is obtained and communicated in the NICU may assist residents in navigating this complex information environment.

The University of Virginia interprofessional education initiative: an approach to integrating competencies into medical and nursing education.

Growing evidence supports the position that interprofessional education (IPE) and collaborative care are essential elements of healthcare education and practice (Institute of Medicine, 2003; World Health Organization, 2010). Nonetheless, there remain significant barriers to integrating IPE experiences in meaningful and measurable ways (e.g. Freeth, Hammick, Reeves, Koppel, & Barr, 2005; Gilbert, 2005; Reeves, Goldman, Burton, & Sawatzky-Girling, 2010). The University of Virginia Interprofessional Education Initiative (UVA IPEI) is a systematic, collaborative effort by the Schools of Medicine and Nursing and the UVA Health System (University Hospital and associated clinical services) to address these barriers in order to create, assess and logically integrate IPE experiences into the education of students in the Schools of Medicine and Nursing.

Using interprofessional team-based learning to develop health care policy

Context and setting The University of Ribeirão Preto Medical School, in Brazil, has a curriculum structured across 6 years. The first 4 years incorporate a problem-based learning approach and are integrated, community-based and student-centred. They are followed by 2 years of clinical internship. The faculty members responsible for clinical education are not involved in the first 4 years. As a result, the values and attitudes developed in Years 1)4 are not sustained or enhanced in the clinical years. Why the idea was necessary A total of 70 faculty members teach in Years 1–4 and 75 teach in clinical internships. There is a 15% overlap between the groups. The small number of faculty who teach across the 6 years has resulted in a gap in the educational structure that is reflected in differences in student attitudes, behaviours and assessment results between the first 4 years and the last 2 years. A significant renewal project is underway to address gaps in the curriculum and in faculty development efforts. Guidelines for the accreditation of Brazilian medical schools emphasise the need for coherent programmes. Our curriculum documents focus on studentand community-centred, integrated programmes, but our clinical internships are teacherand hospital-centred, with specialty-oriented experiences. What was done This project had 2 phases. Phase 1 involved the defining of competencies, objectives and learning opportunities. Phase 2 aligns assessment methods with objectives. Phase 1 involved bridging the gaps in both the curricular structure and faculty understanding of the 6-year programme. A survey was conducted to identify student and faculty perceptions of the education and assessment provided during clinical internships. Four workshops were conducted to sensitise people to and raise awareness of the problem. We took advantage of the accreditation visit to motivate faculty and introduce change. The initial plan was to change both years of the internship but we recognised the need to begin on a smaller scale and learn from the process. Focus groups were conducted with faculty from the infectious diseases rotation to build a curriculum blueprint based on the Accreditation Council for Graduate Medical Education Outcome Project (2006) (http://www.acgme. org/Outcome/) and the Association of American Medical Colleges guideline Educating Medical Students, Report 1 (1999) (http://www.aamc.org/meded/ msop/). The blueprint will serve as a guide for developing a coherent curriculum that includes competencies, objectives, educational opportunities and appropriate assessment methods. Evaluation of results and impact The survey data from students and faculty guided the discussion around curriculum and assessment in the internship. During the first 4 workshops we worked with faculty to introduce concepts of competency, integration and how to link assessment methods to learning methods (experiences in clinical rotations). We also developed a blueprint for a rotation in infectious diseases that connects the internship to the first 4 years, thereby aligning competencies, objectives, opportunities and adequate assessment methods. We have scheduled a training programme on assessment methods focusing on internship faculty members. The gap is narrowing slowly but work will continue with other faculty and other rotations until it is closed.

An Interprofessional Workshop for Students to Improve Communication and Collaboration Skills in End-of-life Care

Interprofessional care is critical for patients at the end of life (EOL), but programs to teach communication skills to medical and nursing students are rare. The aims of this study were to determine whether an interprofessional workshop improves (1) student attitudes toward teamwork and (2) self-efficacy for communicating in difficult situations. Nursing and medical students attended a workshop with collaborative role play of an EOL conversation. Before the workshop, students showed different attitudes toward teamwork and collaboration and varying levels of confidence about communication skills. After the workshop, both groups reported more positive attitudes toward teamwork but a mixed picture of confidence in communication. Experiential interprofessional education workshops enhance perceptions about the benefits of teamwork, but further teaching and evaluation methods are needed to maximize the effectiveness.

Designing and evaluating an effective theory-based continuing interprofessional education program to improve sepsis care by enhancing healthcare team collaboration

Abstract Continuing interprofessional education (CIPE) differs from traditional continuing education (CE) in both the learning process and content, especially when it occurs in the workplace. Applying theories to underpin the development, implementation, and evaluation of CIPE activities informs educational design, encourages reflection, and enhances our understanding of CIPE and collaborative practice. The purpose of this article is to describe a process of design, implementation, and evaluation of CIPE through the application of explicit theories related to CIPE and workplace learning. A description of an effective theory-based program delivered to faculty and clinicians to enhance healthcare team collaboration is provided. Results demonstrated that positive changes in provider perceptions of and commitment to team-based care were achieved using this theory-based approach. Following this program, participants demonstrated a greater appreciation for the roles of other team members by indicating that more responsibility for implementing the Surviving Sepsis guideline should be given to nurses and respiratory therapists and less to physicians. Furthermore, a majority (86%) of the participants made commitments to demonstrate specific collaborative behaviors in their own practice. The article concludes with a discussion of our enhanced understanding of CIPE and a reinterpretation of the learning process which has implications for future CIPE workplace learning activities.

Measuring the impact of clinically relevant interprofessional education on undergraduate medical and nursing student competencies: A longitudinal mixed methods approach

ABSTRACT Interprofessional education (IPE) to improve collaborative competencies is essential for delivering high-quality care. Yet creating clinically relevant IPE and linking it to improvements in behaviours remains challenging, and few objective measurement instruments are available. We developed a process for creating IPE and objective observational tools through collaborative care best practice models (CCBPMs). These models describe the professional and interprofessional behaviours needed for specific patient populations, illnesses, and care settings. Four IPE workshops based on CCBPMs were implemented for all medical and nursing students during their clinical/clerkships years. Students in Cohort 1 completed two IPE workshops: rapid response and end-of-life. For Cohort 2, students completed four IPE workshops, adding chronic paediatric illness and transitions for the cognitively impaired. Valid and reliable collaborative behaviors observational assessment tools (CBOATs) derived from CCBPMs for the rapid response and end-of-life workshops were developed. CBOATs were used in the longitudinal assessment of student learning for both cohorts during two Interprofessional Teamwork Objective Structured Clinical Examinations (ITOSCEs) conducted before and after the students completed the IPE workshops. Over a 2-year period, 457 students completed the IPE simulations and ITOSCEs. Both medical and nursing students demonstrated significant improvement in CBOAT scores. Comparisons between the cohorts showed that participation in four versus two IPE experiences did not significantly improve most CBOAT scores. We conclude that undergraduate IPE simulation experiences based on CCBPMs result in measurable improvements in learner behaviours necessary for effective collaborative and team-based practice in specific care areas.

Interprofessional Education and Practice Guide No. 2: Developing and implementing a center for interprofessional education

Abstract The complexity of implementing interprofessional education and practice (IPEP) strategies that extend across the learning continuum requires that institutions create a structure to support effective and organized coordination among interested administrators, faculty and staff. The University of Virginia Center for Academic Strategic Partnerships for Interprofessional Research and Education (UVA Center for ASPIRE) was formally established in 2013 following five years of dramatic growth in interprofessional education at the School of Nursing, School of Medicine and the UVA Health System. This guide briefly describes the steps that led to the creation of the Center and the key lessons learned that can guide other institutions toward establishing their own IPE centers.

A program design for full integration and assessment of clinically relevant interprofessional education into the clinical/clerkship year for nursing and medical students.

Interprofessional education (IPE) seeks to provide students with the competencies necessary for safe and effective teambased care of patients. However, many IPE experiences are delivered outside of the core curricular objectives for medical and nursing students. This may contribute to the perception that IPE competencies are less valuable than uniprofessional skills; that they are “nice” but not central to student learning. Students must understand that the intraprofessional skills necessary for the kinds of care we deliver cannot be separated from the interprofessional skills necessary to deliver that care effectively. Furthermore, the interprofessional knowledge, behaviors and attitudes needed vary depending on the illness experience, patient population and care setting; therefore, IPE competencies should be learned in their clinical context. To achieve the desired effect of moving IPE from the periphery to a central part of student education, it is necessary to integrate IPE throughout all aspects of the educational environment (Ho et al., 2008), and new educational models must be designed to bridge the gap between IPE and interprofessional practice. Simulation provides an effective setting in which to learn the competencies of collaborative practice without the possibility of placing a live patient at risk (e.g. Robertson & Bandali, 2008; Reese, Jeffries, & Engum, 2010). Simulation also provides the opportunity to identify measurable collaborative skills and to employ observational assessment tools that assess student competencies. Objective structured clinical examinations using simulation are being adopted for many skills, yet few institutions have attempted to use them to longitudinally assess student competencies for interprofessional teamwork (Simmons et al., 2011). Starting in January 2012 and with support from the Josiah Macy, Jr. Foundation, the University of Virginia (UVA) will begin a comprehensive program of implementing and assessing clinically relevant simulated IPE experiences that are fully integrated into the clerkship/clinical year for medical and nursing students.

Innovative interprofessional geriatric education for medical and nursing students: focus on transitions in care.

BACKGROUND Interprofessional education (IPE) is crucial in fostering effective collaboration and optimal team-based patient care, all of which improve patient care and outcomes. Appropriate interprofessional communication is especially important in geriatrics where patients are vulnerable to adverse effects across the care continuum. Transitions in geriatric care are complex, involving several disciplines and requiring careful coordination. As part of the University of Virginias initiative on IPE, we developed and implemented an interprofessional geriatric education workshop for nursing and medical students with a focus on transitions in care. METHODS A total of 254 students (144 medical students, 107 nursing students and 3 unknown) participated in a 90-min interactive, case-based workshop. Nursing and medical faculty facilitated the monthly workshops with small groups of medical and nursing students over 1 year. Self-perceived competencies in IPE skills and attitudes toward interprofessional teamwork were measured through post-workshop surveys. Data were analyzed using descriptive and nonparametric statistics, excluding the three unknown students. RESULTS Over 90% of students were better able to describe the necessary interprofessional communication needed to develop a patient-centered care plan in transitioning patients between clinical sites. Four out of five students reported an enhanced appreciation of interprofessional teamwork. They were also able to identify legal, financial and social implications in transitions of care (75%). Nursing students consistently rated the workshop more highly than medical students across most domains (P < 0.05). CONCLUSIONS Students improved and demonstrated their knowledge of interprofessional communication and teamwork skills required in transitions of geriatric care. Introducing these concepts in medical and nursing training may help in fostering effective interprofessional communication and collaboration.

Effectiveness of an interprofessional workshop on pain management for medical and nursing students

ABSTRACT Interprofessional (IP) care is critical for effective pain management, but evidence is lacking about the best way to teach pain management skills to medical and nursing students using IP strategies. In 2013 and 2014, 307 medical and 169 nursing students participated in an IP case-based pain management workshop. The aims of this study were to determine (1) if students who participate in IP case-based learning groups will have improved pain management skills compared to students who participate in uniprofessional case-based learning groups, and (2) if students mentored by faculty with IP training will have improved pain management skills compared to students who are not mentored by IP-trained faculty. Student learning was assessed and compared using scored checklists for each group’s pain management plans. Findings show that IP mentorship and IP group participation improved medical students’ pain management skills but did not have the same effect on nursing student performance. Continued work is needed to develop, refine, and integrate innovative and tailored IP strategies into the curricula of medical and nursing schools to advance the pain management competencies of students before they enter clinical practice.