Interprofessional Medical Education Research Articles

Making family medicine work: Rural community-based and interprofessional medical education.

At the University of the Free State, the 5-year MBChB curriculum had to be complemented with community-based education exposure to meet the requirements of the Health Professions Council of South Africa. Following the faculty leadership's vision, an interprofessional training experience was conceptualised and implemented by a project team from the three schools in the Faculty of Health Sciences (Medicine, Nursing, and Health and Rehabilitation Sciences). For the past decade, 4th-year medical students participated in the 2-week rotation in the rural southern Free State province, of which 1 week is spent with students from other health professions programmes in a structured interprofessional learning experience. The other week focuses on the realities of nurse-driven primary healthcare services in a resource-deprived area, including exposure to the programme-guided care for patients with tuberculosis (TB) or chronic diseases, care for pregnant women and for babies, including vaccinations.

Abstract WP75: Interprofessional Medical Education in a Stroke Escape Room to Improve Stroke Education and Communication Skills

Purpose: Acute stroke care requires a foundation of clinical knowledge to quickly recognize symptoms and facilitate rapid, safe treatment. Effective care requires a complex network of communication in a stroke response team. Simulation-based training provides a multimodal approach to learning that reinforces clinical knowledge of stroke and affords the opportunity to demonstrate effective communication skills in critical situations. An interprofessional scenario allows all participants to learn about the different roles required for effective care. Methods: Fifty new graduate nurses participated in a pilot model of a traditional didactic session on stroke knowledge, followed by an “escape room” incorporating this knowledge to solve puzzles. The second iteration was expanded to include incoming neurology PGY-2 residents, registered nurses, and pharmacy residents. After the lecture, participants formed teams including equal numbers of all provider roles. The teams were tasked to complete a timed version of the escape room by solving stroke-based puzzles. The escape room was followed by a debrief of communication skills modeled by TeamSTEPPS. Finally, the same teams were exposed to a simulated “stroke code," which included a focused assessment, interpretation of labs and imaging, and management of barriers to treatment with an end goal of collectively managing a suspected stroke. Results: A 5-point scale was used to assess level of comfort with leadership in initial stroke assessment, management, treatment, and communicating concerns. The average increase in numeric level of comfort was 0.9 (range 0.6 - 1.4). The benefit did appear greater for incoming neurology PGY-2 residents (average increase 1.3, range 0.6 - 1.6) compared to registered nurses (average increase 0.45, range 0.25 to 0.75). Conclusions: Use of an escape room during training for incoming neurology PGY-2 residents, registered nurses, and pharmacy residents provided a novel opportunity to facilitate application of clinical knowledge, leadership, teamwork, shared decision-making, and prioritization of patient safety. Providing interactive sessions in between didactic instruction increased participant engagement and level of comfort with roles in a stroke response team.

Measuring the knowledge and perception of Jordanian health science students towards self-prescribed medications: a descriptive analysis study

Abstract Objectives To assess the level of perception and awareness of health science students towards using over-the-counter (OTC) medicines and reveal any malpractice. Methods A descriptive cross-sectional correlational study employing an internet-based self-administered questionnaire collected data from 342 participants. The study model comprised four compartments: introductory, socio-demographic, utilizing OTC medications, and estimating the perception level. Descriptive statistics were used to describe participants’ demographics and main study variables. Non-parametric descriptive analysis and chi-squared tests were used to determine significance across the three medical schools. The response rate among students in their first academic year (33.9%) was the highest. Findings Most participants rely on OTC to treat minor conditions like pain and the common cold. Nutraceuticals have been used heavily. The participants showed a positive attitude towards self-treatment; the average perception score was 3.45 (SD = 0.60; 95%CI: 3.38–3.51). Besides, participants on regularly prescribed medications still determined the interaction between their treatments and non-prescribed medications. No significant association between attitude average score and participant age (r = −0.06; P = .273). Likewise, no differences were found in perceived attitude towards OTC based on gender (P = .41), academic level (P = .223), and college (P = .84). Conclusion This study provides an overview of the level of medical student’s perception towards self-treatment; despite the promising levels of knowledge and perception, it is necessitated to introduce interprofessional medical education to get an integrated knowledge and qualified graduates to provide the best health services.

Virtual Simulation in Undergraduate Medical Education: A Scoping Review of Recent Practice.

Virtual simulation (VS) as an emerging interactive pedagogical strategy has been paid more and more attentions in the undergraduate medical education. Because of the fast development of modern computer simulation technologies, more and more advanced and emerging VS-based instructional practices are constantly increasing to promote medical education in diverse forms. In order to describe an overview of the current trends in VS-based medical teaching and learning, this scoping review presented a worldwide analysis of 92 recently published articles of VS in the undergraduate medical teaching and learning. The results indicated that 98% of included articles were from Europe, North America, and Asia, suggesting a possible inequity in digital medical education. Half (52%) studies reported the immersive virtual reality (VR) application. Evidence for educational effectiveness of VS in medical students’ knowledge or skills was sufficient as per Kirkpatrick’s model of outcome evaluation. Recently, VS has been widely integrated in surgical procedural training, emergency and pediatric emergency medicine training, teaching of basic medical sciences, medical radiation and imaging, puncture or catheterization training, interprofessional medical education, and other case-based learning experiences. Some challenges, such as accessibility of VS instructional resources, lack of infrastructure, “decoupling” users from reality, as well as how to increase students’ motivation and engagement, should be addressed.

Using Design Thinking to Spread iPACE™: An Interprofessional Medical Education Innovation in an Academic Medical Center

Problem Statement: The Interprofessional Partnership to Advance Care and Education (iPACE™) model and its core principles are spreading across the MaineHealth system. Thus, there is a need for a standardized approach that is adaptable and incorporates the requirements of diverse patient care settings.

The Role of Non-Physician Health Care Professionals in the Education of Medical Students at Satellite Campuses

Phenomenon: Satellite campuses of medical schools in Canada introduce smaller communities to new medical learners. Non-physician health care professionals (NPHCPs) in regional hospitals may have had little prior exposure to learners. Lack of clarity regarding the role of the medical student is a barrier that hinders interprofessional collaboration. The purpose of this project was to examine the educational relationship between students and NPHCPs in regional hospitals.
 Approach: Surveys were distributed to NPHCPs of various disciplines at two community hospitals in Waterloo Region. A second survey was distributed to medical students attending a satellite medical campus of McMaster University. 
 Findings: Surveys completed by 141 NPHCPs identified the following themes: frequent student interaction, no orientation to students, uncertainty of roles, willingness to teach, and barriers to teaching. Student surveys demonstrated frequent interactions, lack of familiarity of their role by NPHCPs at regional hospitals, desire to learn from NPHCPs, and specific teachable procedures. 
 Insights: NPHCPs and medical students agree that interprofessional medical education can improve patient care, communication and the quality of education. While there is interest in involving NPHCPs in teaching, orienting NPHCPs to the roles of students in regional hospitals may improve relationships and allow informal teaching opportunities.
 
 Funding: This work was supported by the Michael G. DeGroote School of Medicine, McMaster University.

Teaching Pain Management in Interprofessional Medical Education: A Review of Three Portal of Geriatric Online Education Modules.

Chronic pain is an international healthcare crisis that affects an estimated 1.5 billion individuals worldwide, but pain management is not emphasized in the medical school curriculum, and thus supplemental education is essential. The Portal of Geriatric Online Education (POGOe) is a free repository of teaching modules for use by geriatric educators and learners. This article highlights three teaching modules available on this site: It's My Old Back Again: An Approach to Diagnosing and Managing Back Pain in the Older Adult (POGOe ID: 21670), Computer Based Learning Workbook, Third Edition module on Pain Management (POGOe ID: 21036), and Aging Q3 Curriculum on Pain Management of Older Adult Patients (POGOe ID: 21187). These modules were chosen based on their ability to address the major topics that the International Association for the Study of Pain proposes should be included in medical school curricula: mulitdimensional nature of pain, pain assessment and measurement, management of pain, and clinical conditions resulting in pain in older adults. They were also selected for their ability to be adapted for interprofessional education and how well they integrate basic science and clinical principles.

Impact of Interprofessional Education for Medical and Nursing Students using Simulation Training and a Training Ward: A German Pilot Study

Background: Interprofessional teamwork has become increasingly important to provide patient centered care. Physicians and nurses as two major professions are needed to be adequately qualified. Interprofessional Education (IPE) is an eligible approach. Nevertheless, there is a lack of the impact for both professions. Therefore, we implemented and evaluated simulation training and a collaborative working sequence on a training ward. The aim was to analyze the course structure and assess learning effects to evaluate the suitability for IPE. Methods: A mixed methods study with a sequential explanatory design was conducted. A total of five medical and five nursing students were involved. Students completed questionnaire based interviews after IPE lectures. Two group discussions were conducted to specify and expand quantitative evaluation results. For descriptive statistics, we used the software package SPSS. Both group discussions were analyzed by a qualitative content analysis using the software MAXQDA. Results: Students rated IPE predominantly positive. The learning contents broadness and the links between theory and practice. Students identified six core learning effects: (1) Realization of the importance for collaborative working; (2) Gaining knowledge about the roles of both professions; (3) Realization, that interprofessional care facilitates work; (4) Practicing communication between physicians and nurses; (5) Improving collaborative communication with the patient; and (6) Understanding chances and challenges of joint decision making. Nevertheless, students suggested improvements, e.g., the scenarios of the simulation training should be expanded. Conclusion: The results provide clear evidence that IPE by simulation training and a training ward is feasible and well accepted by students in a German medical school. Results can be used to adapt IPE lectures and to implement them for a larger number of students. The next step is to generalize findings and to sustainably implement IPE in both curricula.

Attitudes toward Healthcare Teamwork between Osteopathic Medical Students in an Interprofessional or Intraprofessional Clinical Education Program

Attitudes toward Healthcare Teamwork between Osteopathic Medical Students in an Interprofessional or Intraprofessional Clinical Education Program

Practice of Camp Style Interprofessional Education for Medical and Health Care Students

Practice of Camp Style Interprofessional Education for Medical and Health Care Students

Board #144 - Research Abstract From ‘There’ to ‘Here’ to ‘Elsewhere’

INTRODUCTION Simulation is gaining international interest as a way to arrange a safe environment for practicing clinical, communicative and interprofessional competence in professional education within health care. However, simulation was originally developed to support and train professionals. The application of medical simulation in interprofessional education for students is still underresearched and undertheorised (1). Recent research and theory argue that professional learning in simulation is embodied, relational, and situated in social-material relations (2,3). Research on how instructional design of simulation as an integrated part of professional curricula support student learning is needed (4), as well as research focusing on what the relevant characteristics of debriefing that lead to effective learning are (1). The aim of this study is to explore the enactment of debriefing as a support for learning in interprofessional medical education simulation.METHODSThis paper draw on findings from a large research project conducted by research environments at Linkoping University (LiU), Karolinska Institute (KI) and University of Gothenburg (GU), Sweden. The data have been collected by standardised video recordings of all phases in the simulation (briefing, simulation and debriefing phases). Totally 30 simulation sessions were video recorded, 10 sessions by each research team. Out of these recordings, 13 simulation sessions were professional teams and 17 sessions were nursing and medical students simulating as a compulsory part of their education in the last semester before graduation. The student sessions are around 18 hours of recordings and altogether 106 students, 71 females and 35 males, participated in the simulation either as active participants in the simulation or as observers. 66 were nursing students and 40 were medical students. The research project has been ethically approved by Linkoping University, Sweden (Dnr 2012/439-31).RESULTSA framework for the analysis of the video recordings was developed on the basis of socio-material theory, with a particular focus on interprofessional collaboration. Sayings, doings and relatings in the debriefing with regard to specific activities or events during the sequence of the scenario were noted through ethnographic field notes and selected segments were transcribed (5). A purposeful constant comparative qualitative analysis (6) was made in three steps comparing sequences of the scenario 1) within a single video recording 2) between different video recordings of the same scenario 3) between video recordings of different scenarios. The findings suggest that interprofessional learning in medical education simulation can become jeopardised in the debriefing. Three interrelated aspects of lacking support for learning were identified, a) debriefing as algorithm or as laissez-faire, b) neglect of team performance as a topic for reflection, and c) time constraints.CONCLUSIONSThe results raise questions whether debriefing in medical simulation as modelled on training of qualified health professionals provides a useful framework applied in undergraduate education with students learning to become health professionals. The experiences of the simulation ‘there’ are intended to become re-contextualised in the debriefing ‘here’. Our findings indicate that the socio-material arrangements of the debriefing instead risk taking the students ‘elsewhere’. Structure or lack of structure of the debriefing seem both to jeopardise the support of interprofessional learning or even overlook interprofessional collaboration as a topic for reflection. The time constraints of the complex logistics of arranging interprofessional simulation-based education as a regular curricular activity for large classes can potentially turn debriefing into a superficial exercise with little or no connection to the intended learning outcomes.REFERENCES1) Issenberg B. Ringsted C. Ostergaard D. Dieckmann P. Setting a Research Agenda for Simulation-Based Healthcare Education. A Synthesis of the Outcome From an Utstein Style Meeting. Sim Healthcare 2011; 6:155–167.2) Nystrom S. Dahlberg J. Hult H. Crossing locations of enacting and observing simulations: Ways of constructing interprofessional learning. Paper to be presented at the Second International ProPEL conference 'Professional Matters: Materialities and Virtualities of Professional Learning', University of Stirling, UK; 2014, 25-27 June.3) Schatzki T. The site of the social: A philosophical account of the constitution of social life and change. University Park: Pennsylvania State University Press; 2002.4) Motola I, Sullivan J, Issenberg S, Devine L, Chung H. Simulation in healthcare education: A best evidence practical guide. AMEE Guide No. 82. Medical Teacher [serial online]. October 1, 2013;35(10):e1511-e1530.5) Heath C. Hindmarsh J. Luff P. Video in qualitative research: analysing social interaction in everyday life. Los Angeles: SAGE; 2010.6) Boeije H. A Purposeful Approach to the Constant Comparative Method in the Analysis of Qualitative Interviews. Quality & Quantity 2002; 36:391–409.

A home for interprofessional medical education at Dalhousie

Dalhousie University in Halifax, Nova Scotia, is constructing a building where students from different health disciplines will learn together both inside and outside of the classroom to better prepare them for working as part of health care teams. “Traditionally, the education of students in

“Surely, We Can Do Better”

To the Editor: A paradigm shift is under way in medical education—or so the myriad responses to Academic Medicine’s 2011 Question of the Year1 suggest. The central argument made by the authors of those responses: The academy must broaden the societal reach of academic medicine to prepare trainees for today’s health care system. To paraphrase Porter and Teisberg2: Surely, we can do better. The challenge is determining how to achieve their collective aim. How do we move from the white paper to the white coat? We believe there needs to be real-time integration of the authors’ varied solutions into a cohesive whole, one that emphasizes translational action. And we need evidence to prove that this transformation is both attainable and desirable. To achieve these goals, we offer a potential model: the VA Connecticut Center of Excellence (COE) in Primary Care Education, established in 2011 by the Veterans’ Health Administration (VHA) Office of Academic Affiliations as one of five national centers focused on interprofessional medical education. We maintain that the principles within this model, stated below, offer potential answers to the challenge before us. First, the foundation of efforts to broaden the societal reach of academic medicine must rely on interprofessional collaboration—a rich and essential component of modern U.S. health care. Second, the curricula for this effort, taught in medical schools, must emphasize the unique skill set that enhances such collaboration, with frontier concepts in public leadership, health policy and economics, negotiation, conflict resolution, improvement science, and political advocacy key to that effort. Third, the education must be immersive, with the longitudinal exposure to meaningful clinical and didactic experiences necessary to equip trainees with skills to generate broad social impact. Team-based delivery models—such as the COE’s clinical practice in the VHA’s Patient Aligned Care Teams, supported by the integrated electronic medical records and global payment systems inherent to the integrated delivery system—may add value. Fourth, modalities linked to improved clinical outcomes, including shared decision making and sustained application of performance and systems improvement strategies, must be integral components of such efforts. Finally, these models must serve as “exemplary care and learning sites,” intended for replication with the potential for rapid, dramatic scaling upward. Achieving the paradigm shift we seek in medical education demands evidence-driven, patient-centered results. Restructuring of traditional medical and nursing education models away from a “siloed” approach toward collaborative learning experiences—within meaningful educational homes—may be the first step. This shift must also include integration of improvement science into all actions and deliberate skill development in policy, management, leadership, and public service. Critics may suggest that it is impossible to integrate these disparate elements into medical education. Our initial experience with the COE model argues otherwise. The societal challenges of our time demand action. Educational models that transform interprofessional education while simultaneously preparing trainees to meet those challenges may be the solution. Disclaimer: The views expressed in this letter are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. Ali M. Khan, MD, MPP Resident director, VA Connecticut Center of Excellence in Primary Care Education, West Haven, Connecticut, and clinical resident in medicine, Yale School of Medicine, New Haven, Connecticut; [email protected] Theodore Long, MD Resident director, VA Connecticut Center of Excellence in Primary Care Education, West Haven, Connecticut, and clinical resident in medicine, Yale School of Medicine, New Haven, Connecticut. Rebecca Brienza, MD, MPH Codirector, VA Connecticut Center of Excellence in Primary Care Education, West Haven, Connecticut, and assistant professor, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.