Transcript Advancing the Nation’s Health through Interprofessional

A Pilot Study to Incorporate
Interprofessional Education with FNP
Students in an Online Program with
Pharmacy Students in a Traditional
Program Using a Blended Approach
Andrea Collins, DNP, NP-C, CNE, COI
Cyndi Cortes, DrPH, MSN, CPNP-PC, COI
Interprofessional Education
Definition
• When students from two or more professions learn about, from, and with
each other to enable effective collaboration and improve health outcomes
(WHO, 2010)
Regulatory Expectations
• AACN - interprofessional collaboration expectations in Essentials for
baccalaureate, master’s, and doctoral education for advanced practice
• Other disciplines (i.e., pharmacy, physical therapy, speech and language
pathology) have also incorporated IPE into accreditation standards
Purpose
• Prepare students for future collaborative practice to the benefit of
individuals, populations, and care delivery systems.
Core competencies for Interprofessional Collaborative Practice
(IPEC expert panel, 2011)
Values and ethics
Roles and responsibilities
• Work with individuals of other
professions to maintain a climate of
mutual respect and shared values
• Use the knowledge of one’s own role
and those of other professions to
appropriately assess and address the
healthcare needs of the patients and
populations served
Interprofessional
communication
Teams and teamwork
• Communicate with patients, families,
communities, and other health
professionals in a responsive and
responsible manner that supports a
team approach to the maintenance of
health and the treatment of disease.
• Apply relationship-building values
and the principles of team dynamics
to perform effectively in different
team roles to plan and deliver
patient/population-centered care that
is safe, timely, efficient, effective, and
equitable.
Strategies
Needs assessment
Institutional support
Identify and train an interdisciplinary IPE team
Design the IPE curriculum
Pilot implementation
Evaluate effectiveness
Identify & train an interdisciplinary IPE team
At least one faculty member from each participating discipline
Highly recommend Interprofessional Education Collaborative (IPEC) for 1st group
Points to address in training:
• IPE
• What is it and why is it needed
• Importance to your institution
• Role biases
• Understand roles and responsibilities and scope of each discipline
• Develop strong collegial collaborative relationships
• Responsibilities in IPE activities
• Creating
• Facilitating
• Debriefing
• Resources for IPE
• What is available
• Where to find it
• Opportunities for collaboration in your setting
IPE curriculum design
Intentionality of interactions
Episodic events or interdisciplinary courses
Online, face-to-face, or hybrid
Graduate or undergraduate or both
Available space
Timing within each program related to level of knowledge
Number of students in each program for equitable representation in groups
Available trained faculty
Activity Design
Core trained faculty group
Routine faculty meetings/communication
Clear faculty roles
Assignment or experience
Congruent with current level of student knowledge
Grading criteria and impact to course grade
Consistent communication (who/how) with students
Graduate IPE Pilot Program
Is there a significant difference in students’
attitudes about IPE before and after the
interprofessional education experiences?
• 50 beginning Family Nurse Practitioner
students and 123 third year pharmacy students
• 21 month timeframe until graduation
• Initial and ending face-to-face sessions on
campus, then online discussion forum
assignments.
Curriculum Design
• Student groups
• Approximately 2 FNP to 5 pharmacy students
• IPE non-credit course in LMS for 21 months
• All students enrolled
• All activities occur in this course
• Initial and ending face-to-face meetings
• Online discussion/assignment each semester
• Related to didactic content current to each
program
• Faculty member of each discipline graded their
students
Timeline for IPE pilot project
Average 2
online
activities per
semester for 5
semesters
Pre-IPE
survey
Face-to-face
Meet and
Greet
Pregraduation
Wrap-up
meeting
Pregraduation
post-IPE
survey
Initial FNP/Pharmacy Interaction
At the Meet and Greet Session, each student asked of his or her group members:
•
•
•
•
•
•
Name/FNP or Pharmacy student
Where are you from originally?
Where do you currently live?
What is your work experience in health care?
What is it that makes you want to become a FNP/pharmacist?
What is the main thing that a FNP/pharmacist will bring to the health
care team?
• What is a job responsibility of a FNP/pharmacist that you think other
health care professionals may not know?
After the session, students answered the following questions on discussion
board of online IPE course :
• What is the most important thing that you learned as a result of your
conversation today?
• What is the most surprising thing that you learned as a result of your
conversation today?
Assignment Examples
Face-to-face
Meet and Greet
Session
Online
Discussion
Questions
Online Quizzes
Wrap-up
meeting
• Get to know group members
• Discuss specific scope of practice questions
•
•
•
•
Scope of practice
Rational prescribing
Medication or diagnosis specific patient education
Practice implications for recent health care trends
or policy changes
• 8 case scenario questions related to medication
and disease management with subsequent group
discussions of rationale and evidence for correct
and incorrect answers
• What was learned about the other discipline
Practical Issues
Differences in curriculum of each program
Differences in philosophy of patient care
Faculty personality and preferred teaching/evaluation methods
Faculty/student comfort with online activities
Online vs. traditional program
Students out of sequence in program
Assessment and Evaluation
Participation
• Almost 100% until last semester
• No real resistance from students
Surveys of student
• Pilot group - pre-pilot and prior to
IPE knowledge
graduation
and perceptions
Grading Criteria
• Based on participation
• Pass/Fail for pharmacy students
• 1% of course grade for FNP students
Pilot Results
• 38 FNP students (86%) and 99 PharmD students
(88%) completed both surveys
▫ Matched pairs
• Not all students completed their programs of study
with the same cohort of students
• Not all students completed both surveys
• Paired t-tests
Demographic Characteristics
Item
FNP
(n, %)
PharmD
(n, %)
Female
26 (68%)
75 (76%)
Male
12 (32%)
24 (24%)
30 years old or younger
14 (37%)
94 (95%)
Older than 30
24 (63%)
5 (5%)
Less than a Bachelor’s degree
13 (34%)
55 (56%)
At least a Bachelor’s degree
25 (66%)
44 (44%)
GENDER:
AGE:
EDUCATION:
Statistically Significant Favorable
Attitude Change (PharmD)
15. I have/had a clear understanding of my
professional role when I interact/interacted with
other health care students.
16. I have/had a clear understanding of the roles
that other health care students have when they
interact/interacted with me.
FNP
4.32
4.32
PharmD
3.93
4.19*
FNP
4.13
3.79
PharmD
3.55
3.86*
Statistically Significant Favorable
Attitude Change (FNP)
21. I would need/need to have face-to-face
interactions with health care students in order
for effective interprofessional education to
occur.
FNP
3.21
2.63*
PharmD
3.66
3.65
Statistically Significant Non-favorable
Attitude Change
11. I could learn/learned valuable aspects about
patient care by working with others from
different health care professions.
14. I do not believe that interprofesssional
interactions regarding patient care will be/are
relevant to me as a health care student.
18. I am interested in interprofessional education.
FNP
PharmD
4.26
4.49
4.16
3.84***
FNP
2.13
1.92
PharmD
1.73
2.04*
FNP
4.16
3.97
PharmD
4.00
3.59**
Response Trends (Same Direction)
10. I believe that interprofessional patient care
teams could decrease health care costs.
FNP
PharmD
4.13
4.48
4.42
4.51
17. I am confident about the beneficial skills
that I personally can bring/brought to an
interprofessional interaction with other health
care students.
FNP
PharmD
4.32
4.08
4.40
4.10
FNP
4.13
4.34
PharmD
3.06
3.26
22. I am comfortable communicating with
others through online discussion boards.
Response Trends (Different Directions)
7. I believe that interprofessional education is
important for health care students to
experience.
8. I believe that interprofessional education
could help to improve patient health outcomes.
9. I believe that medication errors may be
prevented by better interprofessional patient
care.
FNP
4.29
4.50
PharmD
4.50
4.33
FNP
4.37
4.66
PharmD
4.64
4.50
FNP
4.45
4.66
PharmD
4.60
4.47
Study Limitations
IPE process changed for PharmD students
halfway through the 21 month experience
Wording of Item 18 should have been
• “I am interested in online interprofessional education. “
PharmD students had one F2F IPE experience
with other health profession students in
addition to the online IPE experience
• Comparison of experiences could have occurred
Study Conclusions
Results are inconclusive
PharmD students asked not to have
IPE assignments in their P4 year
Consider other types of assignments
• Case studies
• Simulations
• Webinars
Future Considerations
Start IPE from the beginning of
a program to reduce role biases
Introduce online learning
component to students before
requiring online IPE
Tips for IPE success
IPE
curriculum
structure
TRAIN
faculty
TOGETHER
• Mix of courses
and episodic
activities
• Model
collaboration
Intentional,
designed
student
interactions
• Facilitation
and debriefing
References
• Interprofessional Education Collaborative Expert
Panel. (2011). Core competencies for
interprofessional collaborative practice: Report of
an expert panel. Washington, DC: Interprofessional
Education Collaborative.
• World Health Organization. (2010). Framework for
action on interprofessional education &
collaborative practice. Geneva: World Health
Organization. Retrieved from
http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3
_eng.pdf