Training for pre professional students

Over the course of the three years of the Carolina Geriatric Workforce Enhancement Program students in each of the UNC Health Professions Schools will have opportunities to participate in IPE case consultation

Health care teams in the the 21st century require practitioners to be trained to think and act interprofessionally.  Geriatrics patients in particular, benefit from a cohesive, team approach.  To meet these needs the Carolina Geriatric Workforce Enhancement Program (CGWEP) will develop educational experiences where students learn with, about and from each other.  Ultimately this training will be expanded out into clinical settings so that at least 100 students per year are having meaningful clinical IPE experiences that they can then carry forward with them into practice. Faculty at UNC from nutrition, occupational therapy, physical therapy, pharmacy, social work and public health have been promoting IPE for years.  We are very happy that the CGWEP can bring some additional formal resources to this effort. 

Since 2010, a six-hour elective in interdisciplinary teamwork at UNC-CH has engaged at least 100 students annually from nursing, social work, physical therapy, occupational therapy, nutrition, and pharmacy. Student evaluations have identified the most meaningful learning points as

(a) the importance of a collaborative health care/interdisciplinary team;

(b) the value of person-centered, holistic care; and

(c) learning about other disciplines and their scope of practice.

The ultimate success of these efforts will be that all six health science incorporate geriatrics into their curricula. Curriculum will be guided by the Interprofessional Steering Committee. An interprofessional curriculum will be developed to prepare primary care and community-based health care teams statewide to provide quality care to our state’s seniors and the caregivers who assist them. The training will introduce an interprofessional practice model, incorporating staff as possible, and will be customized to the needs of specific practices. Participants will learn about, with, and from each other as they identify practice gaps and where improvements can be made in the care of geriatric patients. Training participants will include physician, nurse practitioner, physician assistant, nursing, medical assisting, front desk/receptionist, and other professions available at the practice (pharmacy, laboratory, etc.). In Year 1, each school’s representatives on the Interprofessional Steering Committee will work with the individual schools to identify the best places to incorporate geriatrics into their curricula and to ensure that the faculty for the designated courses have the requisite knowledge in geriatrics to teach it effectively. Implementation will occur in Year 2. 

Ultimately, our AHEC partners and the primary care practices working in collaboration in this grant will conduct customized trainings at the practice level to address geriatric practice gaps and foster an interprofessional approach to care. Each collaborating AHEC will identify rural primary care practices that see geriatric patients. For each practice, the trainings will assess readiness of staff in a rural, primary care setting to practice as an interprofessional team and to interact with students from different professions.  Steps will include assessing the practice’s current communication among professionals and staff and the current knowledge base related to geriatric care. Input will be obtained from providers, staff, and students working in the practice. Geriatric assessment tools.

Working with geriatric experts at UNC-CH and local providers, AHECs will prepare the curriculum based on the individual practice needs such as geriatric patient assessment, mobility and falls prevention, health literacy, dementia, and overview of mental health first aid. Teaching methods will include case-based
scenarios, group discussions, videos, and skills practice. Sessions will include discussion of each participant’s role and communication among staff.

Progress Report:

The CGWEP work plan develops infrastructure to support the pipeline of providers into geriatric practice.  One of CGWEP’s stated Program goals is to expand an existing pre-professional interprofessional geriatrics curriculum for graduate students and train 100 students from the six health sciences disciplines.  Our team exceeded its goal by training 166 interprofessional students from nine disciplines (Dentistry, Dental Hygiene, Medicine, Nursing, Occupational Therapy, Pharmacy, Physical Therapy, Public Health, and Social Work) during the month of February 2016.  The 166 Health Sciences students completed a two-session, six hour experience entitled “Interprofessional Education Collaborative”, where they practiced interprofessional skills in small groups.  Faculty from all the aforementioned disciplines modeled and coached interprofessional practice using 3 geriatric cases.  Evaluations were received from 96% of the students and analysis is underway.  Project staff are in the process of analyzing the quantitative and qualitative evaluation data from the IPE Geriatrics Preprofessional experience.  UNC-CH has also leveraged interprofessional course development work funded under a small grant from the North Carolina AHEC program. 

Rapid Cycle Quality Improvement:

The CGWEP is committed to continuous improvement and so reviews its projects frequently using a Plan, Do, Study, Act formula.  For this first CGWEP RCQI experience, project staff reviewed the evaluation results from past iterations of the IPE Collaborative experience.  Prior to CGWEP, 53% percent of the prior year’s students completed evaluations.  Thus, RCQI actionable items included:

  • Increase the number of students who complete evaluations.
  •  Increase the number of participating disciplines.
  • Rewrite case scenarios to promote more cross talk.   
  • Give students more guidance that the goal of the exercise is to improve team information sharing, not necessarily get the “right” answer for each of the cases. 
  • Select curriculum methodologies.  The team also debated the pedagogical advantages of using standardized patients or video interviews rather than written cases and including formal instruction on team building.   

A second RCQI cycle is in process following the completion of the first CGWEP cohort of 166 students in February, 2016.  Ninety-six percent of the students completed an online evaluation and a reflection piece on their learning experience.  The evaluation includes reactions to the teamwork process as well as the cross discipline learning.  Project staff will be working with the UNC-CH Odum Institute to statistically analyze the responses.  In addition, qualitative themes are being coded from the free form responses.  The results will guide the implementation of the same experience for students in the next group.   

First is a ten question online Qualtrics survey which asks students how they have formed their ideas about the different health care professions, how knowledgeable they feel about each profession, the impact each profession has on geriatrics and some measures of team effectiveness.  This pre-post survey asks students to predict how the IPE experience will impact their future practice, their job satisfaction, their referral patterns and the quality of care for older adults.  The CGWEP staff will also use thematic analysis to code responses from a four question open-ended questionnaire students completed which explores the factors that help and hinder teamwork in greater detail. 

The Future:

The CGWEP staff are interested in pursuing additional grant funding for IPE practice and are in the process of applying to the American Association of Medical Colleges Group on Educational Affairs and the Kenan Foundation for some modest support.  Dental/dental hygiene and pharmacy faculty have already been awarded a $10,000 grant to solidify involvement of pharmacy students in the dental curriculum and the Steering Committee is also pursuing AHEC Innovation Grants to support the work.  In Year 2 the group plans to increase the number of medical students and retain the faculty who engage in IPE at the preprofessional level while maintaining the large group of trainees (N=100).  The students will benefit from at least two new IPE geriatric cases as well as pursue a strategic publication program.