“Start where you are. Use what you have. Do what you can.” ~Arthur Ashe
Interprofessional education (IPE) is widely recognized as an essential element in the training of healthcare professionals; however, designing and implementing IP educational activities can require overcoming several challenges, including:
- developing IP networks;
- identifying the level at which students in diverse degree programs can meaningfully engage;
- aligning students’ schedules; and,
- advocating for work effort, especially when activities may only occur sporadically.
Despite these challenges, many healthcare professions educators are committed to implementing IPE activities. This post describes one “good” example of implementation of an IPE activity and the surprising positive outcomes we achieved.
In 2015, a couple of faculty members from our university’s Doctor of Physical Therapy (DPT) program attended the first Interprofessional Simulation Conference (IPSC) at Widener University. One of the conference organizers’ goals was for the conference to be held every two years at different host sites. The Emory DPT faculty in attendance picked up the charge and put a call out to recruit faculty involvement from the schools of nursing and medicine, which houses the DPT program and includes a physician assistant program, to host the second IPSC in fall of 2017. Most members of the resulting group did not know each other prior to this experience.
A small group of DPT and Bachelor of Science in Nursing (BSN) faculty who were involved in planning and implementing the conference noted the irony that our university lacked organized IPE opportunities for students, specifically within the context of simulation, and pledged to create and actualize an IP simulation-based learning experience (SBLE). DPT and BSN faculty collaborated with the school of medicine’s human simulation program to incorporate standardized patients (SPs).
DPT and BSN faculty compared curriculums to identify the optimal point at which an IP SBLE would be a meaningful and positive experience for both groups. This was the third of the nine-semester DPT program and the final of the four-semester BSN program. Both groups had covered foundational generalized healthcare knowledge, including introduction to IP collaboration and communication, as well as some profession-specific content. BSN students had completed clinical rotations in various settings; DPT students had not yet entered the clinical area. The rationale behind this seemingly disparate timepoint for students was that we thought that one of the groups needed to be able to bring contextual experience into the SBLE to support fidelity of the activity.
Learning objectives for the SBLE were focused on provision of holistic and competent patient care facilitated by IP collaboration and communication, two of the four core competencies identified by the IP Education Collaborative (2016) as requirements for successful IP teamwork (embed a link to the competencies). Standards of best practice for simulation were adhered to (INACSL Standards) to develop three patient scenarios that required collaboration for patient care. SPs were employed to facilitate interaction and support realism. Debriefing sessions included faculty from both programs.
Prior to and after participating in the SBLE, students completed the Student Perceptions of Interprofessional Clinical Education-Version 2 (SPICE-2) and the Interprofessional Collaborative Competency Attainment Scale-Revised (ICCAS-R) Students also completed an evaluation survey post-SBLE. Student responses indicated that they gained an appreciation for IPE and a better understanding of the roles of other professionals within an IP team. There were more positive shifts in responses from pre- to post-SBLE for the DPT students than for BSN students, which we believe can be attributed to having less clinical experience. In free-text responses, DPT students wrote that they entered the SBLE feeling intimidated by the BSN students due to their clinical experience but that their fears subsided when they found the BSN students to be welcoming and supportive.
The “Perfect Enemy” Didn’t Win
Our first attempt to bring DPT and BSN students together to learn “about, from, and with each other” was far from perfect but proved to be good enough. While the experience didn’t yield statically significant outcomes on our measures, the clinical significance is that simply putting IP students together in the same room to provide patient care provides important experiential exposure to collaborative IP patient care. Students enjoyed the hands-on aspect of the SBLE and interaction with the SPs which was new for the BSN students.
Faculty from the DPT and BSN programs and staff from the human simulation program formed strong connections and experienced great satisfaction by role-modeling IP competencies for students. These relationships fostered not only a connection but also a commitment to this IP effort between our programs. We have implemented the IP SBLE each year, with the exception of a one-year COVID-19 interruption. Each year, we strengthen the SBLE for students and have honed in on more specific learning outcomes. The latest iteration focused specifically on utilization of the SBAR (Situation-Background-Assessment-Recommendation) communication format for patient handoff report. Future goals include adding students from other healthcare professional programs, including physician assistant and nurse practitioner.
Our Message: Just Do It!
If you want to implement IPE at your institutions but are facing logistical and infrastructure challenges, we encourage you to not let that stop you from starting. Do what you can with what you have. Here a few tips:
- Find one faculty colleague from another profession and have a brainstorming session about an IPE activity that you can implement with the resources that you have available to you. Start with a tabletop activity if a clinical unit or simulation space is not available. Take lessons from what went well and what could have gone better to make improvements with each new iteration of the activity.
- Advocate for resources from your program leaders. Help them to see the need for and importance of operationalizing desires for students to gain IP competencies. Use feedback gathered from students to solicit ongoing and increasing support.
- Be persistent. Your first try may not be successful in either the planning or the implementation stage. Take the lessons forward. Reconsider the timing of the activity.
Taking the first step may seem daunting, but the rewards you and your students will reap will provide the momentum for continuing the journey.
“We can do a few things now or everything never.”
~quote attributed to Don Berwick
1.Archibald D, D Trumpower, & CJ MacDonald. Validation of the interprofessional collaborative competency attainment survey (ICCAS). Journal of Interprofessional Care. 2014; 28(6), 553-558.
2. INACSL Standards Committee. INACSL standards of best practice: Simulation – Simulation Design. Clinical Simulation in Nursing 2016; 12, S5-S12.
3. Interprofessional Education Collaborative. 2016. Core competencies for interprofessional collaborative practice: 2016 update. Washington, DC.
4. World Health Organization. 2010. Framework for action on interprofessional education & collaborative practice. Geneva, Switzerland.
5. Zorek, JA, DS Fike, JC Eickhoff, JA Engle, EJ MacLaughlin, DG Dominquez,& CS Seibert. Refinement and validation of the Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education instrument. American Journal of Pharmaceutical Education. 2016; 80(3), Article 47.