Appendix C
Abstracts of the May 1, 2014, Poster Session
CONTENTS
Debora D. Brown, P.T., D.P.T., David Howell, M.B.A.,
Amy E. Leaphart, M.A., M.S.,
Kelly R. Ragucci, Pharm.D., FCCP, BCPS, CDE
The Medical University of South Carolina
Objectives:
- Describe a model of synchronous online activity that promotes a collaborative team approach during community-engaged educational experiences.
- Discuss best-practice elements of this model as they are linked to prior experiences and feedback.
- Assess and evaluate the value and usefulness of a synchronous online interprofessional clinical student activity for creating a collaboration-ready health care workforce.
Background Since 2011, The Medical University of South Carolina has been involved in multiple pilot projects to provide students the chance to meet in small interprofessional groups to discuss clinical cases and strategies to improve care specific to those cases. In response to the difficulty of bringing students on clinical practicums across the country together to meet in person, a pilot program was implemented in 2012 that enabled students to complete the same interprofessional activity synchronously online. The results of this pilot showed that synchronous online case conferences provided a viable opportunity for students to work together during community-engaged education online to share profession-specific knowledge and increase awareness of the value of interprofessional collaboration. In fall 2013, a new program was implemented in order to further improve the process, expand the scope of the pilot, and increase the number of participants and professions.
Methods Pharmacy, physician assistant, occupational therapy, physical therapy, and nursing students participated in a series of online synchronous meetings over 2 months to discuss example cases from their own caseload during clinical experiences. Over the course of the pilot program, students participated in multiple feedback methods (verbal and written, open-ended, and Likert questions) to gauge the student-perceived value of the online
interaction for enhancing care of patients and applicability of the pilot activity to the clinical setting.
Results/Implications Student participant data confirms value and relevance of this pilot project for students in clinical phase of education. In addition, students see applicability of this experience to future community-engaged educational experiences.
C.2
INTERPROFESSIONAL SERVICE LEARNING WITH JUNIOR DOCTORS OF HEALTH
Scotty Buff, Ph.D., M.P.H., Elana Wells, M.P.H., CHES,
Debora Brown, P.T., D.P.T.,
David Sword, P.T., D.P.T., CCS, CSCS, Holly Wise, P.T., Ph.D.
The Medical University of South Carolina
Purpose Junior Doctors of Health (JDOH) is an interprofessional community service–learning project that trains future health professional students (FHPSs) to deliver a dynamic curriculum focused on the prevention of childhood obesity to underserved youth in Charleston and across the state of South Carolina (SC).
Methods FHPS training occurs through recorded and in-person orientations, and FHPSs deliver the interactive JDOH curriculum in interprofessional teams to preschool through eighth-grade youth over the course of four 1-hour sessions. The four sessions are unique to each grade level and include activities covering healthy eating and limiting sugar-sweetened beverages, exercise, health career exploration, and a health advocacy project. The youth graduate and become “Junior Doctors of Health” in which youth are empowered to take control of their own health and educate their family, friends, and community about the importance of healthy eating and exercise. Evaluation of the JDOH curriculum has shown important positive behavior changes in elementary youth and positive knowledge and behavior changes in preschool youth.
Results From 2011 to 2014, 458 students from The Medical University of South Carolina, University of South Carolina, College of Charleston, and Charleston Southern University delivered JDOH to underserved youth across South Carolina. Participating students came from a range of professions including medicine, nursing, occupational therapy, physical therapy, public health, and social work. Students participated in the program through several methods including an elective course, volunteer opportuni-
ties, course integration, and an interprofessional service-learning project in partnership with the South Carolina Area Health Education Consortium.
Conclusions There are several models for the JDOH program to expand to additional university sites interested in incorporating interprofessional service-learning opportunities. These include creating an elective course around childhood obesity, offering volunteer opportunities, or embedding JDOH as a class project within an existing course. Including the service-learning opportunity as a class project has been the most effective way for involving students in the JDOH program. Although course inclusion is not an interprofessional education (IPE) experience in itself, the ultimate goal is to collaborate with additional professions and train students to deliver JDOH in interprofessional teams.
JDOH administration is interested in expanding the JDOH program to additional university sites to reach more youth in underserved communities while providing a boxed service-learning IPE experience for future health professional students.
Funding Sources: Southeastern Virtual Institute for Health Equity and Wellness (SE VIEW), Sherman Financial Group LLC
C.3
A LOOK INSIDE COMMUNITY-BASED SERVICES FOR INFANTS AND TODDLERS WITH SPECIAL NEEDS
Philippa H. Campbell, Ph.D., OTR/L, FAOTA
Thomas Jefferson University
One way that therapy and other developmental health services for families and their infants and toddlers with special needs are provided is through the federal Early Intervention Program, whereby services are provided via professional visits in families’ homes or other community settings. Concepts of family-centeredness underpin this multiple-discipline service program and its central goal of enhancing families’ capacities to meet their children’s special needs. Providers need to be skillful in both teaching families and directly interacting with children to promote use of the recommended practices of family-centered care.
A pilot study was conducted with 51 early-intervention service providers in eight states to explore activities occurring during home visits. Providers represented occupational therapy (19.6 percent), physical therapy (25.5 percent), speech and language pathology (21.6 percent), and developmental teaching (29.4 percent) professions. Providers were primarily Caucasian females with an average of 10.7 years of early-intervention experience.
Providers submitted videotapes of home visit sessions at three time points across an 8-month period with 108 provider-recruited families. Children were primarily Caucasian (72.6 percent) and were described by caregivers as having severe (11.1 percent), moderate (28.4 percent), mild (26.2 percent), or very mild (34.3 percent) disabilities. More than half of the children received occupational and physical therapy and speech and language pathology services on a once-per-week basis for an average of 2.29 hours weekly.
Home visit session videotapes were rated to quantify the extent to which providers used explicit strategies to teach or coach families, one characteristic of family-centered practice. As a whole, caregivers were rated as highly engaged across all three sessions. Coded teaching strategies included provider demonstration of a strategy, caregiver practice with provider feedback, conversation, and problem-oriented reflection. Proportions of use were calculated. As a whole, conversation and caregiver practice with provider feedback were most frequently used. Providers seldom engaged caregivers in problem-oriented reflection. There was little change in the use of strategies across the three visit videotapes. Providers primarily worked directly with children and used explicit caregiver-teaching strategies in less than 20 percent of 30 rated minutes or at an approximate rate of 12 minutes per hour visit. Analyses of various child, caregiver, and provider characteristics with total teaching strategy use at each time point yielded only one significant correlation. Child age was negatively correlated with teaching-strategy use, suggesting that providers were more likely to teach caregivers when children were younger. Other correlations between teaching-strategy use and provider characteristics (e.g., experience and discipline), caregiver characteristics (e.g., race/ethnicity, family socioeconomic status, caregiver education), or child characteristics (e.g., severity, hours of services) were not significantly related to use of teaching strategies.
These data illustrate the limited extent to which multiple-discipline early-intervention service providers directly enhance families’ capacities to meet their children’s special needs through use of caregiver-directed strategies. Results further suggest that health professional education must include as much emphasis on caregiver-directed as child-directed strategies if best practices such as family-centered care are to be scaled up for wide use in community-based settings.
Linda Casser, O.D.,1,2 Melissa Vitek, O.D.,1 Valerie Pendley, M.D.3
1 Pennsylvania College of Optometry at Salus University
2 Association of Schools and Colleges of Optometry
3 Chestnut Hill Family Practice
Background and introduction A doctor of optometry (O.D. or optometrist) is an independent primary health care professional who is trained, educated, and credentialed to examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures, and who identifies related systemic conditions affecting the eye and visual system. An optometrist has completed preprofessional undergraduate education and 4 years of professional education at a school or college of optometry, leading to the Doctor of Optometry degree.
Established in 1941, the Association of Schools and Colleges of Optometry (ASCO) is the academic leadership organization committed to promoting, advancing, and achieving excellence in optometric education. ASCO has achieved this objective by representing the interests of institutions of optometric education, enhancing the efforts of these institutions as they prepare highly qualified graduates for entrance into the profession of optometry, and serving the public’s eye and vision needs. ASCO proudly represents all 21 accredited schools and colleges of optometry in the 50 states and Puerto Rico, including the Pennsylvania College of Optometry (PCO) at Salus University in Philadelphia, Pennsylvania.
Salus University and its component colleges and programs—the Pennsylvania College of Optometry, the Osborne College of Audiology, the College of Education and Rehabilitation, the College of Health Sciences, and the Graduate Programs in Biomedicine—are committed to creating models and promoting a culture of interprofessional education that aligns with the university’s vision to be recognized nationally and internationally for excellence and innovation.
Methods Beginning in October 2012, the Eye Institute of PCO and Chestnut Hill Hospital Family Practice, Philadelphia, Pennsylvania, have
collaborated in health professional education and collaborative patient care by developing and implementing an interprofessional model in which second-year family medicine residents participate in weekly sessions of active observation of comprehensive eye and vision patient care at the community-based Chestnut Hill satellite facility of the Eye Institute of the Pennsylvania College of Optometry at Salus University.
Results and discussion A total of 12 residents have participated in approximately two weekly sessions of patient care each since the initiation of the program. The family medicine residents have demonstrated a special interest in the triage of patients with urgent eye conditions, the differential diagnosis of patients presenting with red eye, ocular manifestations of systemic disease, clinical signs and management of glaucoma, and ophthalmic evaluation of the pediatric patient. The optometry students, family medicine residents, and faculty members have engaged in discussions regarding the assessment and management of patients with hypertension, uncontrolled diabetes, and other systemic conditions.
The family medicine residents initially taking part in the program were so pleased with their experience during the primary eye and vision care sessions that they requested an additional weekly session with the optometrist who specializes in pediatrics. The implementation of this additional session has taken place, and the family medicine residents state that it has added tremendous value to their clinical rotation. The interprofessional education and collaboration also reaches beyond the clinical activity: two optometrists have lectured to the family medicine residents during their regularly scheduled meetings. These lectures have been well received, and plans to expand this element of the collaboration are under discussion. Topics for the collaborative lectures have included components of a comprehensive eye and vision examination, ocular urgencies and emergencies, the differential diagnosis of a red eye, and pediatric eye and vision disorders.
Conclusion On a direct level, this initiative has allowed practitioners from both professions to gain further respect for each profession’s contribution to patient care. On a larger scale, the collaboration represents a synergistic model of interprofessional health care and education. Most important, this collaborative approach to patient care and clinical education promises more effective health care delivery, ultimately leading to improved patient outcomes. The member institutions of ASCO, including students, residents, and faculty members, remain committed to effective community-based health professions education, IPE, and collaborative patient care.
C.5
THE ECONOMIC IMPACT OF A STUDENT-RUN FREE CLINIC AS A SAFETY NET PROVIDER FOR UNINSURED PATIENTS
Sara Kraft, P.T., D.P.T., NCS, ATP, Gretchen Seif, P.T., D.P.T., OCS,
Patty Coker-Bolt, Ph.D., OTR/L, Wanda Gonsalves, M.D.,
Emily Johnson, Kit Simpson, Ph.D.
The Medical University of South Carolina
The Student-Run Free Clinic (SRFC) serves a vital role as a safety net provider by providing free health care to indigent patients. This study examined (1) the potential reimbursable care provided at a SRFC and (2) the cost of potential emergency room (ER) visits avoided by patients seen at the clinic. This retrospective study involved a review of charts, services, and procedures at both medical and rehabilitation student-run clinics at The Medical University of South Carolina. Services delivered were estimated using evaluation and management (E&M) codes for moderately complex new patients and potential therapy Medicare billing codes. Additionally, all patients seen were asked if they would or would not have gone to the ER had they not come to the clinic. The SRFC provided 1,556 patient medical and therapy visits in 2011 for $145,496 in health care services, resulting in approximately $762,832 in potential annual ER visit costs avoided. Additionally, 276 total patients were turned away, which resulted in an estimated $245,196 in ER costs per year that could have been avoided if the SRFC had had adequate capacity. SRFCs perform a valuable service as a safety net provider with cost saving to the community.
Khalid G. Mohamed, M.D.,1,2,3 Steiner Hunskaar, M.D., Ph.D.,1,2
Samira Hamid Abdelrahman, M.B.B.S., M.Sc., D.P.H.,1
Elfatih Malik, M.D.,3 Jan De Maeseneer, M.D., Ph.D.4
1 University of Gezira, Medani, Sudan
2 University of Bergen
3 Ministry of Health, Medani, Gezira State, Sudan
4 Primafamed-Network, Ghent University (Belgium)
Introduction There is a huge problem of scaling up capacity in family medicine in Africa. Most of the training for family medicine takes place in hospitals. Since 2008, the Primafamed-Network has brought together experiences in Africa to create a “learning community.”
Background In 2010 the Gezira Family Medicine Project was initiated following an in-service training model in Gezira state, Sudan. It is a collaboration project between the University of Gezira, which aims at providing a 2-year master’s program in family medicine for practicing doctors, and the Ministry of Health (MoH), which facilitates service provision and finances the training program.
Methods In this observational study, a self-administered questionnaire was used to collect baseline data at the start of the project from doctors who joined the program. A checklist was used to assess the health centers where they work. A total of 188 out of 207 doctors responded (91 percent). Data were gathered from all 158 health centers (100 percent) staffed by the program candidates.
Results The Gezira model of in-service family medicine training succeeded in recruiting 207 candidates in its first batch, providing health services in 158 centers, of which 84 had never been served by a doctor before. The curriculum is community based and community oriented. The project used a limited amount of traditional teaching, and the majority of the training was done in health centers. Online seminars and lectures were given in addition to regular supervision and opportunities for feedback through telemedicine in order to have a backup for difficult cases. The questionnaire was able to detect the areas where participants had high confidence (asthma management, postabortion uterine evacuations) and those where they were least confident (managing depression). A concern was the technical equipment of the health centers.
Conclusion This approach, with a 2-year postgraduate in-service program, provided a good model. The community-based training is highly motivating. And the fact that trainees provide care at the local level is much appreciated and contributes to scaling up the capacity of primary health care.
Use of modern information communication technology facilitated both health care provision and training.
Shelley Cohen Konrad, Ph.D., LCSW,
Jennifer Morton, D.N.P., M.P.H., APHN,
Jan Froehlich, Donna Gaspar Jarvis
University of New England, Portland, Maine
Background The CHANNELS (Community, Health, Access, Network, Navigate, Education, Leadership, Service) Project is a community-based initiative designed to prepare future health professionals with culturally appropriate skills to serve with and on behalf of underserved and vulnerable populations. The CHANNELS Project has three aims: (1) education for culturally informed collaborative practice, (2) community nurse leadership, and (3) community outreach and health promotion. This abstract focuses on the education arm of the project, which implemented innovative training and teaching strategies grounded in core interprofessional collaborative competencies, team-based person-centered care, cultural preparedness, and social enterprise directed toward community outreach. This integrated curriculum is co-taught by interprofessional faculty in collaboration with community health outreach workers (CHOWs) who serve as cultural navigators. Learners include two distinct groups: health professions students who take these classes in interprofessional classrooms and community professionals involved with CHANNELS’s diverse aims.
Purpose The CHANNELS project’s education arm concurrently teaches integrated skills for cultural competence, health literacy, and collaborative practice. The core learning objectives include teamwork and collaborative practice, which promote positive team working skills; cultural awareness and identity that reflects upon learners’ assumptions, beliefs, and biases and raises awareness of power inequities and health disparities; cultural knowledge, which exposes learners to culturally appropriate attitudes, resources, and skills; and health literacy and communication.
Methods/Design The integrated curriculum was co-designed by an interprofessional faculty group, CHOWs, community partners, and students. Learning objectives were crafted to transcend learners’ levels and were implemented using a range of teaching methods. Cohorts of students from across disciplines were determined by matching courses that included common content that did not add to faculty’s teaching loads. Community partner trainings were offered to all CHANNELS partners. All learning sessions
were evaluated. Students completed reflective assignments using prompts that paralleled desired learning outcomes.
Results/Findings Students from six different professions completed the integrated curriculum over 12 months. Feedback was generally positive with students recognizing the importance of gaining skills in the domains described. Student comments indicated a desire to move past talking about skills toward applying them in clinical and community settings. Faculty found that each cohort required revision to customize teaching methods. In addition, the more successful sessions were made up of professional students who could envision working together in the future. Lastly, students gained significant awareness and knowledge from learning with and about the CHOWs, and especially from their stories, which brought the health perspectives of immigrants and refugees into sharper focus.
Conclusions/Lessons learned Lie and colleagues (2012) note that cultural competency and health literacy, though intricately related to one another, are mostly taught separately in health professions education. Interprofessional education strategies, whereby students learn about, from, and with each other, are natural environments to teach these important areas of knowledge concurrently and in collaborative learning settings. Learning in this way prepares students to work more effectively in health environments where they encounter diverse and unfamiliar cultures. Coordinating with CHOWs as co-teachers enhanced the learning experience for both students and faculty involved with the development of the education arm of the CHANNELS project.
C.8
THE ROLE OF COMMUNITY HEALTH OUTREACH WORKERS IN ACHIEVING THE TRIPLE AIM
Malual Mabur, M.D., Siyad Ahmed, Kolawole Bankole, M.D., M.S.,
Toho Soma, M.P.H., Jennifer Morton, D.N.P., M.P.H., APHN
University of New England, Portland Campus
Background The role of community health outreach workers (CHOWs) in many parts of the world has been revered as integral to health care teams, not only to improve the cultural appropriateness and quality of care services to their communities, but to help to reduce the health care service system costs. In areas where integrated health care teams provide an array of services, the CHOW role is very crucial to its success. Portland, Maine, is a resettlement area that is home to more than 8,450 (13.5 percent of
Portland population of 65,000) foreign-born immigrants, refugees, and asylum seekers.
Methods The purpose of this project is to measure the value of the CHOW role according to the Institute for Healthcare Improvement’s Triple Aim (population outcomes, patient experience, lower costs). The CHANNELS program (Community, Health, Access, Network, Navigate, Education, Leadership, Service) funded by the Health Resources and Services Administration (HRSA) proposes innovative community-based strategies to improve the health of immigrant and refugee communities in the Southern Maine area.
There are three arms of the project: education, training, and service delivery. All three arms include the role of the CHOWs as cultural brokers and medical interpreters. Three CHOWs were hired for the project that speak the most predominant languages (Arabic/Sudanese, Somali, Spanish) in the Portland area. Additionally, they are leaders within their own communities as well as having special insights into the cultural nuances embedded in those communities. The project also has hired and trained a number of per diem CHOWs for other prominent languages and cultures.
Outcomes There is a plethora of literature on the value that CHOWs bring to communities with respect to the patient experience and short-term outcomes; however, little evaluation exists that measures cost-effectiveness and long-term outcomes of patients and communities. This project uses a multifaceted evaluation approach that includes perceptions and attitudes of team-based care (CHOW included), Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), clinical use data, and the electronic medical record. Early outcomes reveal that care for this population, when accompanied by CHOWs, improves access and adherence.
In summary, projects that truly “measure the difference” at a time when health reform is more important than ever will serve as an impetus to include CHOWs as health care organizational hires.
Karen T. Pardue, Ph.D., R.N., CNE, ANEF,
Jennifer Morton, D.N.P., M.P.H., APHN
University of New England
Background Nurses working in population-oriented settings often face large caseloads, underfunding, and limited resources. Although the state of Maine and select municipalities house a modest public health infrastructure, the needs of many communities exceed the few positions dedicated to addressing the health of the state. Population health outcomes are optimized when nurses possess strong leadership skills, engage in shared decision making, and demonstrate capacity for interprofessional collaborative practice (IPCP) approaches to care. Nurses serving in community and public health roles commonly lack access to formalized IPCP training and leadership development. In an effort to address this need, the University of New England launched a Population Focused Nurse Leadership Institute funded by a HRSA Nursing Education Practice Quality and Retention (NEPQR) IPCP project titled CHANNELS.
Purpose The purpose of the institute is to provide a forum for community and public health nurses to enhance their skills and capacity in team-based collaborative leadership when working with vulnerable populations. The institute brings together emerging nurse leaders for four sessions over 9 months to focus on personal leadership development, leadership within interprofessional teams, and leadership within a community of interest. Enhancement of leadership and collaborative practice abilities provides impetus for population-based quality improvement, heightened systems thinking, and the delivery of safe, effective, and equitable care. This aligns with the Robert Wood Johnson Foundation/Institute of Medicine The Future of Nursing (IOM, 2011) report that advocates for nurses to lead teams to improve health systems, engage in lifelong learning, and assume leadership roles in advancing change and promoting health.
Methodology An institute planning team was convened reflecting expertise in public health, care of vulnerable communities, curriculum development, and leadership. Participants were recruited from a broad array of state and municipal public health employers, as well as home care/Visiting Nurse Association, school health, and ambulatory clinics. Twelve participants enrolled in year 1, reflecting the practice sites of schools (urban and
rural), HIV care, homeless health care, immunization/communicable disease management, home care and hospice, and ambulatory care (immigrant urban setting). The four meeting sessions were interactive and included facilitation from regional and national nurse leaders, interprofessional practice experts, and institute faculty. Each participant completed a DISC (Dominance, Influence, Steadiness, Conscientiousness) Work of Leaders profile, rendering a framework to examine the process of leadership and to appraise personal leadership strengths and challenges. Leadership within IPCP was explored, along with core competencies reflective of collaborative practice. The uniqueness of population-based nursing practice was analyzed, advancing the constructs of community as partner, cultural humility, and health literacy. Participants applied their leadership training in proposing an evidence-based population-oriented project designed to improve aggregate health outcomes, a system issue, or a public health practice concern.
Results/Recommendations The planning team and project evaluator are conducting a review of the collective impact of the evidence-based projects in an effort to further describe health disparities in the communities of interest and the impacts of the identified interventions. The collective contributions of this first cohort will be disseminated through scholarly presentations and publication. The evaluation team plans to longitudinally track the trajectory of this first cohorts’ transition from emerging nurse leader to one of leveraging capacity and influence in the delivery of population-based health care.
Robb Russell, D.C.
Southern California University of Health Sciences
Nicholas De Groot, N.D.
Canadian College of Naturopathic Medicine
Myles Spar, M.D., M.P.H.
Venice Family Clinic
John Weeks
Academic Consortium for Complementary and Alternative Health Care
Purpose The purpose of this poster is to summarize the rationale and typical partnership models for this community-service movement in integrative health and medicine education.
Methods Data from a prior Academic Consortium for Complementary and Alternative Health Care (ACCAHC) survey of the extent of partnership models in all accredited programs will be shared. Two examples will be described: a Los Angeles–based community clinic in which medical students from University of California, Los Angeles, work in teams with students from an institution that educates chiropractic doctors and two acupuncture and Chinese herbal medicine schools; and a hospital-based clinical training program in the Greater Toronto area created via a partnership between the hospital and a college of naturopathic medicine.
Results Factors driving development of the two community-based programs will be described. Among these are growing interests of educators in providing experience with patients who are less likely to come to school teaching clinics; providing experience in integrated and interprofessional environments; and assisting these facilities in offering such services to their clientele. The business model usually includes the integrative health academic institution providing the on-site faculty to oversee the education and treatment with a cadre of senior students and the free provision of services.
Discussion The central challenge for academics in the licensed integrative health and medicine disciplines of providing community-based education turns the conventional system on end. Students in these fields typically gain clinical education through community-based outpatient teaching clinics associated with the schools and via preceptorships in solo or group practices of licensed members from their fields. To better imbed their clinical education in the community, many of these institutions are establishing relationships with conventional delivery system providers such as hospitals, federally qualified health centers, physician groups, community clinics, and senior homes. The client populations are frequently communities that are underserved, and particularly underserved for treatment by integrative health and medicine practitioners. Clinicians gain the opportunity to see new populations and participate in varying degrees in interprofessional and team care in these integrated, community environments.
Conclusion The clinical education experiences created through partnerships between integrative health and medicine academic institutions and mainstream delivery organizations can provide student clinicians access to new populations and offer opportunities for interprofessional and team-care experiences.
C.11
WALKING A MILE IN THEIR BOOTS: AN IMMERSIVE, COMMUNITY-BASED
EDUCATIONAL EXPERIENCE
Adam Saperstein, M.D., Paul Pasquina, M.D., Chelsea Garner, B.S.,
Daniel Lammers, B.S.
Uniformed Services University of the Health Sciences
Background With a motto of “Learning to Care for Those in Harm’s Way,” the Uniformed Services University of the Health Sciences (USUHS) is the premier Health Sciences Center for educating students about the unique aspects of military medicine in general, and care of the warrior in particular. Although community awareness is often taught using traditional educational strategies, these may limit the learner’s ability to obtain an authentic view through the lens of the community. One possible solution is incorporation of a community-based, immersive educational strategy. Such a first-person experience helps the learner relate to the community, appreciate its needs, and learn from community members. In this case, our community consists of wounded warriors and their families.
Pilot program USUHS is co-located on the same campus with Walter Reed National Military Medical Center. Wounded warriors at the center are involved in a number of therapeutic activities, including the Creative Arts Program (CAP) and Adaptive Sports Program (ASP). In September 2013, in collaboration with directors of the CAP and ASP, we developed and implemented an elective immersive educational experience called “The Wounded Warrior Partnership” (WWP). From all medical students in the class of 2016, 38 volunteered for the program, and 20 were randomly selected to participate. Of those selected, 50 percent were assigned to the CAP and 50 percent to the ASP with a requirement to attend at least one event lasting 2 to 5 hours per month. Students also participated in discussion groups at the end of each month.
Benefits of the program and lessons learned At the end of 4 months, all 20 students, faculty facilitators, and program coordinators discussed lessons learned. One hundred percent of students reported that their involvement in the program offered them the following benefits:
- Better perspective for, and a greater sense of, responsibility to the community served
- Greater insight into their own personal reactions when caring for those with a chronic illness or disability
- Increased confidence in engaging with a member of one’s community
- Enhanced and sustained capacity for empathy
- Greater appreciation for the needs of those from a wide array of socioeconomic backgrounds
- Enhanced awareness of what it means to be a health care professional
Representative quotes included
- “The WWP allowed me to experience and not just be told about some aspects of the lives of wounded warriors and their families. This will not only help me to better care for them but to consider the perspective of all my patients and enhance my empathy.”
- “I really enjoyed having the opportunity to reflect on my experiences during my participation in the WWP. These discussions helped me to process my experiences in a way that is sure to help me be a more compassionate and competent physician.”
Conclusion This immersive pilot program demonstrates a novel approach to community-based education and affords participants a perspective they would be unlikely to gain through traditional educational approaches. Our strategy can be readily implemented in a number of different settings, and it can be tailored to meet the needs of learners, faculty members, and their communities. Further study to evaluate benefits of this and similar programs is planned for the future.
Gretchen Seif, P.T., D.P.T.,1 Sara Kraft, P.T., D.P.T.,1
Patty Coker-Bolt, O.T., Ph.D.,1
Wanda Gonsalves, M.D.,2 Kit Simpson, Ph.D.,1 Emily Johnson1
1 The Medical University of South Carolina
2 University of Kentucky College of Medicine, Louisville, KY
Student-run free medical clinics are a type of health care delivery program in which students take primary responsibility for clinic logistics and operational management. The Community Aid, Relief, Education and Support Clinic (CARES) is an example of an interprofessional student-run
free medical clinic at The Medical University of South Carolina (MUSC) where students from multiple disciplines and colleges work together to serve the uninsured patients in the community. Since 2005, this service learning experience has enhanced the preclinical experience of medical, occupational therapy (OT), physical therapy (PT), pharmacy, and physician assistant (PA) students.
Although student-run clinics are lauded for their potential to teach students clinical skills, medical humanism, and professional generosity, there are no studies that have measured the student learning outcomes from participation in these clinics. The purpose of this study was to examine the learning outcomes of OT, PT, PA, medicine, and pharmacy students that participated in the CARES student-run free medical and therapy clinics.
The experimental group consisted of preclinical OT, PT, PA, medicine, and pharmacy students (n = 101) enrolled in an interprofessional (IP) course, Caring for the Community—A Service-Learning Elective. The control group consisted of students from each academic program that did not participate in the CARES class, or students who may only have volunteered in the CARES program (n = 232). Students were administered three assessments, the Interprofessional Education Perception Survey (IEPS), the Reflection for Interprofessional Learning Scale (RIPLS), and the Self-Assessment of Clinical Reflection and Reasoning (SACRR) at the beginning and end of each semester.
Students who participated in the CARES IP class and medical and therapy clinics showed a significant change in self-rated measures of interprofessionalism and clinical reasoning after participation in hands-on learning at the clinic (P = 0.02). There was no effect or significant change for students that were in either of the control groups (P = 0.55). Improvements were seen in attitudes toward interprofessional cooperation, teamwork, collaboration, professional identity, roles, and responsibilities.
The study suggests that service learning, as opposed to only volunteerism at a student-run free clinic, can impact clinical reasoning in PT, OT, PA, pharmacy, and medical students. Service learning is typically associated with projects relating to the services rendered. These projects give students the opportunity to synthesize the information gathered from their service, which in turn makes it more meaningful. The students can process effective versus ineffective treatments through analysis leading to better clinical reasoning. In addition, students begin to consider the importance of working in a health care team in order to provide the highest level of care in today’s health care environment.
Funding Source: The Medical University of South Carolina Interprofessional Grant
Diana G. Venskus, P.T., Ph.D., Victor Betancourt-Santiago,
Douglas Ball, Ph.D.,
Theresa Cappello, Ph.D., Faith Claman, D.N.P., R.N.,
Aly Eisenhardt, D.H.S., MHSA,
Sonia Hernandez, Ph.D., Sherri Hughes, Ph.D.,
Diane Murphy, Ph.D.
Marymount University
Background and purpose Global perspective is an academic outcome of engagement within the global community that facilitates development of social responsibility in professional practice. This administrative case report details the evolution of a global partnership as a strategy for interdisciplinary student engagement in the advancement of a developing nongovernmental organization (NGO) in Costa Rica.
Case description Marymount University (MU) is a student-centered academic institution motivated toward service and integration of student experiences within the global community. Fundación Hogar Manos Abiertas (Manos Abiertas) is a developing NGO dedicated to the care of and attention to persons with physical and mental ailments. International Service Learning (ISL) is an international educational NGO that coordinates medical and educational teams for the provision of services to underserved populations. The alignment of shared mission and values among these partners guided the work culture and mutually determined priorities in this project. Curricula coordinated across programs and schools engaged students at MU in the development and advancement of Manos Abiertas as a maturing organization.
Outcomes One hundred forty-nine students and 12 faculty members representing 6 unique programs in 4 of the 5 academic units (schools) at Marymount University participated in the organizational development activities at Manos Abiertas in Costa Rica. The results—the student products embedded within the curriculum—include
- Establishment of physical therapist services,
- Advancement of the organizational structure,
- Organizational and operational improvements,
- Reassignment of special education resources and programs,
- Development of a model electronic medical record,
- Coordinated interprofessional care plans,
- Implementation of skilled nursing practices, and
- Professional staff development and training—all at Manos Abiertas.
Discussion Global engagement designed within the curriculum may be used successfully to advance developing organizations and guide student participation as professionals responsible for addressing needs across global communities.
Benita Walton-Moss, Ph.D., FNP-BC,1 Anne Lin, Pharm.D., FNAP,2
Andrea Parsons Schram, D.N.P., CRNP, FNP-BC,1
Laura Hanyok, M.D.,1
Nicole S. Culhane, Pharm.D., FCCP, BCPS,2
Angela M. McNelis, Ph.D., R.N., ANEF, CNE,3
Paula Teague, D.Min., M.B.A., B.C.C.,4
Thomas Crowe M.Div.,5 Jennifer Hayashi, M.D.,4 Nathan Poole, M.A.,1
Kathleen Becker, D.N.P., ANP-BC1
1 Johns Hopkins University
2 Notre Dame of Maryland University
3 Indiana University School of Nursing
4 Johns Hopkins Bayview Medical Center
5 Johns Hopkins Hospital
Background Future health care providers will be required to work in high-functioning interprofessional teams. For educators, developing innovative methods that teach real-world clinical practice in a cost-effective, productive, and high-quality manner is essential. In response to these directives, we are implementing a longitudinal educational project to integrate IPE and clinical technology into the delivery of care to medically complex homebound elders.
Objectives This longitudinal project creates interprofessional teams of students/trainees to learn team-based interprofessional skills in the context of providing care to the vulnerable homebound elder. Unique aspects of this project include the use of simulation technologies, development of a
student/trainee-led home visit model, and facilitated reflection and debriefing methods.
Methods Graduate nurse practitioner students, pharmacy students, internal medicine residents, and chaplain trainees are participating in a longitudinal experience consisting of four online learning modules, an intensive session of team-building exercises, a standardized patient clinical simulation, and up to three student/trainee-led home visits, followed by self-debriefing or facilitated debriefing. Reflection on the experience is encouraged using journaling and team assessment following each home visit.
Results Program implementation began in fall 2013. The program’s effect on learner IPE attitudes and beliefs will be assessed with pre- and postlearner surveys, using the Modified Attitudes Toward Interprofessional Health Care Teams (ATHCT) and the Interprofessional Socialization and Valuing Scale (ISVS). We will qualitatively analyze the learner journaling reflections to identify themes. Preliminary data will be available in summer 2014. Baseline results will be presented as well as challenges in project implementation.
Implications Developing and implementing a longitudinal interprofessional education program focused on integrating technology with home-based care is feasible. Data on the effects on learners will be presented and implications will be discussed.
C.15
TAKING INTERPROFESSIONAL EDUCATION (IPE) FROM CLASSROOM TO COMMUNITY: THE I-TEETH PROGRAM
Mayumi A. Willgerodt, Ph.D., M.P.H./M.S., R.N., Debra A. Liner, PMP,
Jennifer Sonney, M.N., ARNP, Elizabeth Velan, D.M.D., M.S.D.,
Rebecca Fischer, Doug Brock, Ph.D.
University of Washington
The goal of interprofessional education (IPE) is to foster collaborative practice by providing shared learning opportunities among health professions students. By learning with, about, and from each other, students learn principles of teamwork and communication that they can apply in practice. Great strides have been made in addressing the Interprofessional Education Collaborative (IPEC) competencies but often in isolated classes, courses, or projects. Further, a preponderance of IPE efforts has been focused on prelicensure students; advanced health trainees such as advanced practice registered nurses, social workers, and medical and dental residents are in need of
learning opportunities that are grounded in an interprofesssional pedagogy and situated learning in the community. Importantly, opportunities for joint training along the educational and learning continuum are needed.
The purpose of this presentation is to describe i-TEETH (interprofessional Teams Engaged in Education and Training in Health), a sequential interprofessional curriculum piloted with pediatric nurse practitioner trainees and pediatric dental residents. Curricula were developed with three goals: (1) allow trainees to experience the learning continuum together (exposure, immersion, integration), (2) allow trainees to move together along the didactic-to-practice continuum, and (3) address content and skill gaps in existing curricula. In consultation with educators and practitioners, the training program consisted of three phases, designed to progressively build upon each other so trainees were able to learn together both didactically and clinically and translate learned skills into practice. Trainees first took a multistep online module that included IPE and team training concepts, a group exercise, and content on growth and development and oral health. Parts 2 and 3 included an in-person seminar and a half-day clinical experience at a community-based clinic—the Center for Pediatric Dentistry. In the seminar, trainees collaborated in small groups to develop optimal care plans for several pediatric oral health cases featuring children and teenaged patients with special needs. During the half-day clinical experience, pediatric nurse practitioners and dental residents were paired together to teach each other how to conduct developmental assessments, oral health assessments, and skills such as the application of fluoride varnish. The interprofessional pairs jointly provided care to the children in the clinic. The end-of-program evaluations revealed that the trainees derived great value from the experiences, particularly the opportunity to learn and practice together in the community. Trainees reported an increase in knowledge and appreciation of the other profession’s skills, the importance of team communication, and an increase in confidence in performing both team and oral health/developmental assessment skills. Not surprisingly, lessons learned included the need for long-term advanced planning, more faculty development, and more interactive training time for the trainees. Plans for expansion are under way to include social work trainees, family nurse practitioners, and family medicine and pediatric residents. This pilot provides the foundation for creating community-based interprofessional models of learning that are simultaneously intentional and integrated.
The authors gratefully acknowledge the mentorship of Brenda Zierler, Ph.D., R.N., FAAN, and the assistance of Gail C. Johnson, D.N.P., ARNP, and Trilby Coolidge, Ph.D.
This project was funded by the Josiah Macy Jr. Foundation and HRSA.
REFERENCES
IOM (Institute of Medicine). 2011. The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.
Lie, D., O. Carter-Pokras, B. Braun, and C. Coleman. 2012. What do health literacy and cultural competence have in common? Calling for a collaborative health professional pedagogy. Journal of Health Communication 17:13-22.
