A large body of research supports the need to embed inter-professional (IP) education into health science student preparation to improve population and community well-being (Interprofessional Education Collaborative, 2011; Reeves, Pelone, Harrison, Goldman, & Zwarenstein, 2017; World Health Organization, 2010). Yet, numerous challenges continue to face faculty teams to integrate effective and sustainable IP education into curriculums (Cahn, 2014), and many graduates of health science programs lack the skills and confidence needed to incorporate multiple providers' perspectives when designing coordinated care outcomes as a member of IP teams (Gilligan, Outram, & Levett-Jones, 2014; Roberts, Davis, Radley-Crabb, & Broughton, 2018).
This article highlights the findings of a longitudinal cross-sectional study of a newly developed hybrid IP course using the veteran population as exemplars. The purpose of this study was to assess changes in student perspectives toward providing coordinated IP care to veterans. Data were collected during four consecutive semesters from 2015 to 2018.
The pedagogy for this course rests on cultivating student willingness to engage in IP care for diverse and complex patient populations. An IP faculty teaching team developed four independent hybrid modules based on the 2011 Interprofessional Education Collaborative (IPEC) competencies: ethics, roles and responsibilities, communication, and teamwork. The veteran population was selected to provide examples of key aspects of these competencies because many veterans' behaviors are guided by a defined ethical code. In addition, veterans understand unique roles and responsibilities, their communication is clear and concise, and they count on teamwork. The health needs of veterans are broad and provide students rich opportunities to design IP care addressing social, economic, behavioral, environmental, and biological health risks. Veteran care is not a traditional focus for professions within individual curriculums; therefore, this course added a new perspective for all students.
Course content was presented online and face-to-face using classroom, clinical, and community settings. A mix of graduate and undergraduate prelicensure students from health informatics, nursing, occupational therapy, physical therapy, and social work could attend any combination of the freestanding modules. Instruction included methods commonly supported in the literature such as case studies (Levett-Jones et al., 2018; Weidman-Evans, Bigler, Murray, & Wright, 2017; World Health Organization, 2013), standardized patients (Krueger, Ernstmeyer, & Kirking, 2017; Liaw, Zhou, Lau, Siau, & Chan, 2014), problem-based learning (Bar, Leurer, Warshawski, & Itzhaki, 2018; Dreier-Wolfgramm, Homeyer, Oppermann, & Hoffmann, 2018), and simulation (Costello et al., 2017; Krueger et al., 2017; Liaw et al., 2014).
To help students translate the key elements of IP practice into population health, members of the veteran community helped design case studies, volunteered to be interviewed as standardized patients, and presented portions of the course. These learning experiences occurred virtually or face-to-face with veterans and Veterans Health Administration (VHA) teams of providers. Examples of the learning experiences include exercises designed to explore professional and veteran cultures and how learned roles and responsibilities affect the care expectations of veterans who experienced sexual trauma, environmentally acquired conditions (e.g., cancer, stress, amputation, or head trauma), and observe dynamic IP teams modeled by VHA Patient Aligned Care Teams (PACT). A brief overview of the course is provided in Table 1.
Overview of the Interprofessional Care of Veterans Population Course
Design and Measures
Institutional review board approval was obtained for this study. All senior baccalaureate nursing students who were enrolled in all four modules of the IP care of the veteran course at a small private college in the rural Midwest were invited to participate.
The IP Attitude Scale (IPAS) was selected to measure changes in student attitudes toward IP work. The IPAS includes 27 Likert-type items that measure student attitudes toward team-work, roles and responsibilities, patient-centeredness, IP biases, diversity and ethics, and community-centeredness (Norris et al., 2015). Researchers have reported sound reliability and validity of the IPAS (Coiro & Preis, 2018). A convenience sample of students completed the IPAS during the first and last week of class. Using SPSS® version 25, nonparametric calculations revealed possible changes in student attitudes toward IP work.
Anecdotal data derived during the course from various assignments and open-ended questions on course surveys was collected with student permission. Six structured questions helped to generate and guide written or oral responses about student perceptions related to IP work. Qualitative description was used to identify commonalities in student reflections and responses to open-ended survey questions (Sandelowski, 2000).
Of 173 eligible nursing students, 162 participated in this study (94%). The majority of the nursing students were female (92%) and white (96%) with an average mean age of 22 years (SD = 0.82; mode = 22; range, 21 to 42 years).
In general, pre- and postcourse responses were skewed toward the higher end of the 5-point Likert-type scale (1 = strongly disagree and 5 = strongly agree). Nursing students' point of view seemed to change significantly toward teamwork, community centeredness, and biases with effect sizes (r) ranging from .33 to .51. Students' beliefs on shared learning seemed to help them think positively about other professionals, improve communication among different professionals and patients, improve their teamwork abilities while gaining a better understanding of their own limitations, and expand their understanding of clinical problems. Students' perceptions about health professionals and students from other disciplines having prejudices or making assumptions about them decreased following the course.
Student perceptions about IP experiences seemed to echo the changes in student attitudes revealed by the IPAS. Early in the course, nursing students identified numerous dissimilarities between various professions. One student wrote, “[there is] a general disconnect between students from different professions in understanding the components of each discipline's knowledge and scope.” At the end of the course, this student's reflection captured many of the perceptions recorded by the participants about their IP experiences:
[By] seeing different points of view and deciphering which occupation's responsibilities were more important for the patient was the biggest challenge…. [I] feel more comfortable with what each health care professional's roles were and what kinds of things I can collaborate on with them…. This experience helped me feel more confident approaching someone outside my profession.
The intent of this course was not to establish IP competency, but to inspire students to engage in IP work. Findings derived from the IPAS and anecdotal data seem to imply that this hybrid course helped prelicensure nursing students gain an appreciation of the distinctive professional qualities their IP peers contribute toward improving the health of veterans. This positive attitude toward IP work may encourage students to develop the skills and confidence needed to integrate various providers' perspectives when coordinating care for complex patients. A willingness to coordinate care for patients from diverse backgrounds as a member of an IP team is a valuable asset for students entering health care professions.
During the first four semesters when data were collected, minor changes to this course occurred to clarify content delivery. Student, faculty, and veteran experiences guided these modifications. Study results helped to inform various curriculum development committees of the value of IP learning.
There is no one ideal IP education approach. A strong, imaginative, and resilient IP faculty team is critical to the success of embedding IP processes within content-saturated education schemas and engaging students across professional silos. By blending prelicensure graduate and undergraduate health science students, the IP learning environment expanded students' experiences. Although these student groups may differ developmentally and are learning to approach care from different lenses (e.g., holistic or focus on treating distinct patient issues), the small IP group activities compelled students to teach each other either face to face or virtually. Creating a unique teaching platform where the veteran community and students work together to explore various perspectives associated with population health appears to be an effective IP education approach.
Education is one of the catalysts that helps students change perspectives and align their practice with current and future technology and approaches to care. Engaging and nurturing colleagues to shift paradigms and promote IP practices is critical to advancing the health of diverse populations and professional satisfaction. Hopefully, this example will encourage educators to implement innovative and practical IP education within their own educational context.
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- Krueger, L., Ernstmeyer, K. & Kirking, E. (2017). Impact of interprofessional simulation on nursing students' attitudes toward teamwork and collaboration. Journal of Nursing Education, 56(6), 321–327. doi:10.3928/01484834-20170518-02 [CrossRef]
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Overview of the Interprofessional Care of Veterans Population Course
|Module||Core Content||Activitya||Student Outcome|
|Ethics||Military sexual trauma and other “hidden injuries”||Review blog post of a veteran's experience
Examine various codes of ethics to identify IP overlap||Evaluate a paper case study with four unique ethical dimensions and devise an IP team care decision using an ethical framework|
|Roles and Responsibilities||Roles and veteran care coordination
Scopes of practice and academic preparation of different professions||Post voice thread elevator speech highlighting each unique profession's roles and responsibilities within team||Team PowerPoint® presentation highlighting distinct and shared roles and responsibilities of care coordination for veteran exemplar|
|Communication||TeamSTEPPS®b (2008) and ISBARR®||Accomplish an individual intake interview with a veteran patient
When all interviews are completed, patients debrief students underscoring veteran perspectives||As an IP team, create a blended IP ISBARR® handoff video|
|Teamwork and Collaboration||Analyze aspects of highly functional IP teams
Explore how personalities affect teamwork||Identify self and team members' collaboration strengths through low stakes team-building exercises
Video conference with VA PACT||Instructor-led discussion highlighting how individual personality traits affect IP team effectiveness|