Early outcomes from a national Train-the-Trainer Interprofessional Team Development Program.

The imperative need to train health professions faculty (educators and clinicians) to lead interprofessional education efforts and promote interprofessional team-based care is widely recognized. This need stems from a growing body of research that suggests collaboration improves patient safety and health outcomes. This short report provides an overview of a Train-the-Trainer Interprofessional Team Development Program (T3 Program) that equips faculty leaders with the skills to lead interprofessional education and interprofessional collaborative practice across the learning continuum. We also describe the history, approach, and early outcomes of this innovative program.

Measuring the Impact of the National Train-the-Trainer Interprofessional Team Development Program (T3-ITDP) on the Implementation of Interprofessional Education and Interprofessional Collaborative Practice.

BACKGROUND: In order to prepare current and future educators and clinicians to lead interprofessional education (IPE) and interprofessional collaborative practice (IPCP), faculty and staff need training in collaborative approaches to developing, implementing, assessing, and sustaining high quality IPE across the interprofessional learning continuum. The Train-the-Trainer Interprofessional Team Development Program (T3-ITDP) is a 3.5-day program designed to develop expert IPE teams through interactive workshops, coaching, and the development and implementation of an IPE or IPCP (IPECP) project for their home institutions. PURPOSE: The purpose of this research was to assess the impact of the T3-ITDP on the development and implementation of IPECP projects by participating teams. METHODS: The T3-ITDP impact survey was created and administered to collect data on the scope and impact of participant teams' projects, including learner and project outcomes, training methods, dissemination plans, assessment strategies, and teams' intentions to continue working together beyond the initial project. With human subject's approval, we invited 55 T3-ITDP participant teams to complete the impact survey. These teams were at least one year post-completion of the in-person portion of the program and thus had time to initiate their IPECP projects. RESULTS: Forty-one (74.5%) teams responded to the survey. Of those teams, 31 (76%) used T3-ITDP content and/or approaches to develop their IPECP projects that targeted learners across the interprofessional learning continuum. Sustainability of IPECP projects was supported through several mechanisms, including institutional support or incorporating IPECP activities into existing courses. Almost half of the teams worked together on new projects, and 74% of teams planned to repeat a newly developed activity. DISCUSSION & CONCLUSIONS: Results of the T3-ITDP impact survey demonstrated that team-based, project-focused professional development catalyzed the development, implementation, and sustainment of new IPECP projects at academic and community institutions throughout the U.S.

The ASPIRE Model: Grounding the IPEC core competencies for interprofessional collaborative practice within a foundational framework.

Interprofessional education (IPE) and interprofessional collaborative practice (ICP) are essential to achieving high-quality patient care. Leading IPE/ICP requires training in new knowledge and skills that most health professions faculty and clinicians lack. To guide this training, the Interprofessional Education Collaborative (IPEC) defined interprofessional collaboration through four core competencies: (a) Values/Ethics for Interprofessional Practice, (b) Roles/Responsibilities, (c) Interprofessional Communication, and (d) Teams and Teamwork. For IPE/ICP training to be effective, it is necessary to identify new educational models that provide an operational framework for these competencies. The University of Virginia (UVA) ASPIRE Model is a new paradigm for developing IPE/ICP educational experiences. It was created by mapping the IPEC competencies to three overlapping curricular content areas: (a) Practical Tools, (b) Leadership, and (c) Relational Factors. This model shows the relationship among the four IPEC core competencies and corresponding sub-competency statements and their inclusion in one or more of these three curricular content areas. The UVA ASPIRE Model was empirically tested as an approach to provide IPE/ICP training through "real-world" application for clinicians and faculty participating in an intensive team development program. Positive evaluations and improved capabilities of learners to apply their new knowledge and skills to solving real-world clinical challenges revealed that the UVA ASPIRE Model is an effective approach to embed the IPEC competencies in the design of IPE/ICP educational activities.

HPNA 2019-2022 Research Agenda: Development and Rationale.

Building on the strong work of previous research agendas (2009-2012, 2012-2015, 2015-2018), the Hospice and Palliative Nurses Association Research Advisory Council developed the 2019-2022 Research Agenda in consultation with Hospice and Palliative Nurses Association (HPNA) membership and assessment of major trends in palliative nursing. The HPNA Research Advisory Council identified 5 priority areas and asked subject experts in each area to summarize the state of the science, identify critical gaps, and provide recommendations for future research. This document expands the executive summary published on the HPNA website (www.advancingexpertcare.org/hpna/) and provides supporting evidence for the 2019-2022 recommendations. The 5 priority areas are as follows: (1) pediatric hospice and palliative nursing research; (2) family caregiving; (3) interprofessional education and collaborative practice; (4) big data science, precision health, and nursing informatics; and (5) implementation science.

Developing an Innovative Statewide Infrastructure and Model for Delivering Continuing Interprofessional Education: The North Carolina AHEC Initiative.

INTRODUCTION: North Carolina AHEC (NC AHEC) leadership recognized that continuing interprofessional education (CIPE) is vital for improving patient care and outcomes. Rather than train and educate in professional silos, interprofessional education presented an opportunity to reframe continuing education (CE) to improve the integration of care delivery and outcomes. METHODS: In April 2014, two regional AHECs collaborated to design a statewide initiative for AHEC CE leaders, CE professionals, and CE faculty to learn about integrating interprofessional education into CE planning and implementation. The design of this innovative initiative develops a common knowledge base in CIPE, promotes collaboration, avoids duplication, and creates shared definitions and standards to advance CIPE across the NC AHEC program. RESULTS: The NC AHEC CIPE Initiative drew participation from CE leaders, CE professionals, and CE faculty. Immediately after the completion of the Initiative, seven AHECs completed CIPE events. By June 2017, AHECs across the state had offered a total of 36 CIPE events. DISCUSSION: The NC AHEC CIPE Initiative demonstrates that it is possible to implement CIPE programming in a regional CE context. The education model promoted changes in knowledge, competence, and performance of CE professionals and faculty. Critical success factors include leadership support, functioning as a community of practice, engaging experts to train CE professionals and faculty, and using technology to span geographic distance of learners.

Measuring the impact of clinically relevant interprofessional education on undergraduate medical and nursing student competencies: A longitudinal mixed methods approach.

Interprofessional education (IPE) to improve collaborative competencies is essential for delivering high-quality care. Yet creating clinically relevant IPE and linking it to improvements in behaviours remains challenging, and few objective measurement instruments are available. We developed a process for creating IPE and objective observational tools through collaborative care best practice models (CCBPMs). These models describe the professional and interprofessional behaviours needed for specific patient populations, illnesses, and care settings. Four IPE workshops based on CCBPMs were implemented for all medical and nursing students during their clinical/clerkships years. Students in Cohort 1 completed two IPE workshops: rapid response and end-of-life. For Cohort 2, students completed four IPE workshops, adding chronic paediatric illness and transitions for the cognitively impaired. Valid and reliable collaborative behaviors observational assessment tools (CBOATs) derived from CCBPMs for the rapid response and end-of-life workshops were developed. CBOATs were used in the longitudinal assessment of student learning for both cohorts during two Interprofessional Teamwork Objective Structured Clinical Examinations (ITOSCEs) conducted before and after the students completed the IPE workshops. Over a 2-year period, 457 students completed the IPE simulations and ITOSCEs. Both medical and nursing students demonstrated significant improvement in CBOAT scores. Comparisons between the cohorts showed that participation in four versus two IPE experiences did not significantly improve most CBOAT scores. We conclude that undergraduate IPE simulation experiences based on CCBPMs result in measurable improvements in learner behaviours necessary for effective collaborative and team-based practice in specific care areas.

Interprofessional training enhances collaboration between nursing and medical students: A pilot study.

BACKGROUND: Effective collaboration among healthcare providers is an essential component of high-quality patient care. Interprofessional education is foundational to ensuring that students are prepared to engage in optimal collaboration once they enter clinical practice particularly in the care of complex geriatric patients undergoing surgery. STUDY DESIGN: To enhance interprofessional education between nursing students and medical students in a clinical environment, we modeled the desired behavior and skills needed for interprofessional preoperative geriatric assessment for students, then provided an opportunity for students to practice skills in nurse/physician pairs on standardized patients. This experience culminated with students performing skills independently in a clinic setting. RESULTS: Nine nursing students and six medical students completed the pilot project. At baseline and after the final clinic visit we administered a ten question geriatric assessment test. Post-test scores (M=90.33, SD=11.09) were significantly higher than pre-test scores (M=72.33, SD=12.66, t(14)=-4.50, p<0.001. Nursing student post-test scores improved a mean of 22.0 points and medical students a mean of 11.7 points over pre-test scores. Analysis of observational notes provided evidence of interprofessional education skills in the themes of shared problem solving, conflict resolution, recognition of patient needs, shared decision making, knowledge and development of one's professional role, communication, transfer of interprofessional learning, and identification of learning needs. CONCLUSIONS: Having nursing and medical students "learn about, from and with each other" while conducting a preoperative geriatric assessment offered a unique collaborative educational experience for students that better prepares them to integrate into interdisciplinary clinic teams.

Designing and evaluating an effective theory-based continuing interprofessional education program to improve sepsis care by enhancing healthcare team collaboration.

Continuing interprofessional education (CIPE) differs from traditional continuing education (CE) in both the learning process and content, especially when it occurs in the workplace. Applying theories to underpin the development, implementation, and evaluation of CIPE activities informs educational design, encourages reflection, and enhances our understanding of CIPE and collaborative practice. The purpose of this article is to describe a process of design, implementation, and evaluation of CIPE through the application of explicit theories related to CIPE and workplace learning. A description of an effective theory-based program delivered to faculty and clinicians to enhance healthcare team collaboration is provided. Results demonstrated that positive changes in provider perceptions of and commitment to team-based care were achieved using this theory-based approach. Following this program, participants demonstrated a greater appreciation for the roles of other team members by indicating that more responsibility for implementing the Surviving Sepsis guideline should be given to nurses and respiratory therapists and less to physicians. Furthermore, a majority (86%) of the participants made commitments to demonstrate specific collaborative behaviors in their own practice. The article concludes with a discussion of our enhanced understanding of CIPE and a reinterpretation of the learning process which has implications for future CIPE workplace learning activities.

Integrating interprofessional education into continuing education: a planning process for continuing interprofessional education programs.

Informal continuing interprofessional education (CIPE) can be traced back decades in the United States; however, interest in formal CIPE is recent. Interprofessional education (IPE) now is recognized as an important component of new approaches to continuing education (CE) that are needed to increase health professionals' ability to improve outcomes of care. Although there are examples of CIPE programs that are being successfully implemented, a clearly articulated, step-by-step planning process to help guide educators in providing effective CIPE programs is lacking. This lack of guidance poses a significant barrier to increasing the number of CIPE programs in the United States. In this article, we describe a process for developing, implementing, and evaluating CIPE programs using the familiar systematic CE planning process. Limitations of traditional CE also are addressed, and the relationship between CIPE and other new approaches to CE is clarified. Four examples of CIPE programs are provided to illustrate how the planning process can be adapted to include IPE, while implementing recommended changes in traditional CE offerings. The article is concluded with a discussion of some of the challenges that will face CE educators in moving toward a new vision of CE integrated with IPE.

Predicting rural practice using different definitions to classify medical school applicants as having a rural upbringing.

PURPOSE: This study determines the relationship between a medical school applicant's rural background and the likelihood of rural practice using different definitions of rural background. METHODS: Cohort study of 599 physicians who entered the University of Virginia School of Medicine in 1990-1995 and graduated in 1994-1999. The "rurality" of the applicants' backgrounds was assessed by coding applicants' high school, college, and permanent addresses using 4 definitions of rural. In addition, most physicians responded to a survey question "Did you grow up in a rural area?" The same 4 definitions of rural were used to assess the rurality of practice locations. Logistic regression models were used to predict the simultaneous effect of different definitions of rural background, gender, and applicants' career preference at matriculation on the probability of practicing in rural areas. FINDINGS: In univariate analyses, the high school, college, and permanent addresses were all predictive of rural practice using 1 or more definitions of rural. In the multivariate analysis, only the "grew up rural" self-description was predictive of rural practice location using 3 of the definitions of rural. In a secondary analysis, the grew up rural self-description and applicants' career preferences at matriculation were predictors of rural practice. CONCLUSIONS: Readily available addresses were predictive of rural practice. In a multivariate analysis, physicians' self-description about having grown up in a rural area was the best predictor of rural practice. Recruiting more applicants who match this definition of rural background should increase the number of rural physicians.

Effect of a second-year primary care preceptorship on medical students' career plans.

BACKGROUND: Preceptorships with community physicians have been incorporated into medical curricula to foster interest in generalist careers. An evaluation of our preceptorship program was undertaken to determine this influence. METHODS: Students were asked about career interests before and after a second-year community preceptorship. When graduating, those students entering primary-care residencies were surveyed to validate whether they planned to become generalist or specialist. Associations between career choice at graduation and career interest before and after the preceptorship were examined. RESULTS: Of 73 students who maintained a generalist career plan after the community preceptorship, 57 (78%) continued with the same at graduation. After the preceptorship, 70 students reported a change in career interest toward generalism, compared with 9 who reported an interest in specialism. A significant relationship was found between career interest change and career choice at graduation. CONCLUSION: Our community preceptorship had a modest impact in stimulating students to consider generalist careers.

Can medical school admission committee members predict which applicants will choose primary care careers?

PURPOSE: To determine the accuracy of admission committee members' predictions regarding which applicants are likely to become generalists, and to determine which applicant characteristics are used and should be used in making these predictions. METHOD: Thirteen characteristics of each applicant who entered medical school in 1990-1993 and graduated in 1994-1997 were obtained from their applications. Committee members reviewed these characteristics and assigned a probability of each applicant's choosing a generalist career. Just before their graduation, the students were surveyed to ascertain their career plans. The relationships between the characteristics and career predictions were analyzed using regression models. A secondary analysis examined the relationship between the students' stated career preferences at matriculation and career plans at graduation. RESULTS: The accuracy of the committee members' predictions was low. Predictions of generalist careers were significantly related to seven applicant characteristics: rural legal residence, gender (women), lower science grades, lower MCAT science scores, lower levels of parents' education, no reported research activity, and higher levels of community service. In contrast, the students' actual generalist career plans at graduation were significantly related only to gender (women) and higher levels of community service. In the secondary analysis, applicants' stated career preferences at matriculation were the strongest predictor of their having generalist career plans at graduation. CONCLUSIONS: Admission committee members often made inaccurate predictions about applicants' career plans. This may be because they based their judgments on applicants' characteristics that were not significantly related to the students' career plans at graduation.