An Interactive, Adaptable Interprofessional Healthcare Team Roles & Responsibilities Workshop for Preclinical Medical Students
Submitted by Tia Kostas on Apr 25, 2022 - 11:39am CDT
Authors
Tia Kostas, MD,1 Joyce W. Tang, MD,2 Anshu Verma, MD,2 Valerie G. Press, MD, MPH,1 Leah Kelemen, BA,3 Jennifer Austin Szwak, PharmD, BCPS,4 Christina Bernhardy, LCSW,5 Kaveri Bhatnagar Chopra, MA, CCC-SLP,6 Eric Bulgarelli, PT, DPT, PCS7 Roy Horton, PT, DPT, OCS, FAAOMPT,7 Kelsey Reif, MS, RD, LDN,8 William Madden, PharmD, BCGP,4 Patricia MacClarence, LCSW,5 Jessica Schultz, MS, RD, LDN,8 Zachary M. Stapleton, PT, DPT, OCS7 John F. Cursio, PhD,9 Katherine Thompson, MD1
1Associate Professor, Department of Medicine, University of Chicago Medicine
2Assistant Professor, Department of Medicine, University of Chicago Medicine
3Research Assistant, Department of Medicine, University of Chicago Medicine
4Clinical Pharmacist, Department of Pharmacy, University of Chicago Medicine
5Social Worker, Department of Social Work, University of Chicago Medicine
6Speech-Language Pathologist, Department of Speech-Language Pathology, University of Chicago Medicine
7Physical Therapist, Department of Physical Therapy, University of Chicago Medicine
8Clinical Dietitian, Department of Nutrition, University of Chicago Medicine
9Research Assistant Professor, Department of Public Health Sciences, University of Chicago Medicine
Abstract
Introduction: Interprofessional education (IPE) and collaboration have been shown to have a positive impact on patients, the community, and professional practice. IP collaboration is vital to providing optimal care to older adults. However, crowded student curricula, lack of access to other professional healthcare trainees, and limitations on in-person learning can make it difficult to carry out meaningful interprofessional (IP) activities. Methods: A required half-day interprofessional workshop (IPW) was developed for first-year medical students to improve competency in the Collaborative Practice Competencies Roles/Responsibilities domain. After the pilot year, pharmacy students were invited and joined the medical students at this workshop. The workshop was adapted to virtual format during the COVID-19 pandemic. Participants completed pre- and post-IPW surveys; IPW facilitators completed post-IPW surveys. The workshop consisted of a large group didactic, small group breakout sessions led by facilitators from different healthcare professions, and a large group wrap up. Results: Student response rates: overall 72% (336/469); medical student 76% (284/372), pharmacy student 46% (45/97). IPW facilitator response rate was 76% (22/29). Participant self-rated ability to perform the Roles/Responsibilities competencies showed statistically significant improvement for all 9 competencies among all participants, medical students alone, and pharmacy students alone. Most (93%) of students agreed that the IPW should be continued for future students. All 22 responding IPW facilitators agreed that the session was valuable, giving medical students a better understanding of their profession; they reported interest in participating again in the future. Discussion: The IPW can significantly improve students’ self-rated ability in the Collaborative Practice Competencies related to Roles/Responsibilities. The IPW is a high yield IPE opportunity that can be carried out at institutions that have limited access to a variety of healthcare professions trainees or have limitations on in-person learning.
Introduction
Interprofessional education (IPE), in which students from more than one health profession learn together for the purpose of improving collaboration and patient outcomes,1 can facilitate interprofessional collaboration among healthcare team members.2 IPE has increasingly become an important element of the curriculum at many health professions schools over recent years.3 The Interprofessional Education Collaborative has created Collaborative Practice Competencies comprising 4 domains: Values/Ethics for interprofessional (IP) Practice, Roles/Responsibilities, IP Communication, and Teams and Teamwork.3 Students need to understand early in their professional careers their own roles and responsibilities as well as those of others on the IP team. This knowledge will then provide them a basis to develop their competencies in the other three domains as they progress through their training program.
Numerous IPE activities have been developed that require the participation of students from multiple schools of healthcare professions and often involve case-based exercises. For example, at one institution, students from five healthcare-related professions (medicine, nursing, dentistry, public health, and informatics) were brought together for a 3-hour clinical simulation experience with standardized patients.4 Another example is a 3-hour IP standardized patient exercise involving dentistry, physical therapy, medical student, social work, nutrition, and chaplain trainees.5
However, our institution, like some others, is limited by the lack of schools of multiple diverse healthcare professions. For example, we have a medical school, but no schools of nursing, pharmacy, physical therapy, speech-language pathology, or nutrition. Thus, in order to provide our medical students with experiences in IPE and/or IP collaboration we need to develop innovative experiences for our students. A needs assessment survey conducted several years ago of graduating medical students and their faculty preceptors at our institution demonstrated that both students and faculty felt that students did not receive sufficient IPE experiences during the students’ medical school training.6 We therefore sought to develop new, creative, interactive educational interventions that would expose pre-clinical medical students to healthcare practitioners they will interact with as part of an interprofessional team and which could be carried out without ready access to learners from other healthcare professions.
During the COVID-19 Public Health Emergency, nearly all healthcare professions schools have had to deal with limitations on in-person learning in order to curb the spread of the coronavirus. Since we were unable to hold the IPW in person, we adapted the IPW to a fully virtual experience, conserving as much of the interactive portions of the workshop as possible.
There have been IPE courses developed at other institutions for pre-clinical medical students which run over the course of an academic year involving a combination of workshop and experiential activities.7 However, given the scheduling constraints of the pre-clinical curriculum at our institution we felt it to be in our students’ best interest to develop a workshop-based activity during the first year of medical school, while focusing during the second year of medical school on experiential clinical IPE activities, such as the Pharmacy Clinical Experience.8
We thus developed the Interprofessional Workshop (IPW), a half-day interactive educational experience focusing on the Collaborative Practice Competencies Roles/Responsibilities domain. The workshop targets medical and pharmacy students. As a one-time half-day experience, the IPW can fit into busy medical and pharmacy school curricula, and can be adapted based on the IP facilitators available at one’s institution and the need for in-person vs. virtual instruction.
Methods
We created an Interprofessional Workshop embedded within first-year medical students’ first longitudinal clinical experience, the Longitudinal Program (LP), at a medical school affiliated with a tertiary medical center. In the LP, students were paired with a physician preceptor with whom they conducted clinical observation sessions in an outpatient clinic or Emergency Department over the course of a year. One requirement of the LP was that students had at least one in-person interprofessional observation experience with a non-physician healthcare provider (e.g. medical assistant, social worker, nurse, etc.) Students were also required to attend this half-day IPW, which took place in the fall of the first year of medical school, from 2017-2020.
Pharmacy student participants were from a neighboring health professions school whose students had clinical rotations at the tertiary medical center affiliated with the medical school. Pharmacy students were in their third or fourth years of pharmacy school. This was an elective experience in 2018 and 2019, and it was required for all third-year pharmacy students in 2020.
The in-person IPW was conducted on two days, with half of the students attending workshop #1, and the other half attending workshop #2, based on students’ obligations for other courses. The virtual IPW was conducted on one date with all students attending this one session. The in-person workshop was conducted in a large classroom with AV capabilities, with 5 smaller rooms utilized for small group breakout sessions. The virtual IPW was conducted over Zoom.
In-Person Roles & Responsibilities Interprofessional Workshop
The IPW Director utilized Appendix A. In-Person IPW Director Overview, to plan and organize the IPW. The IPW began with the IPW Student Pre Workshop Survey (Appendix E), followed by a 20-minute didactic presentation (In-Person IPW Didactic, Appendix B) given by the IPW Director (a physician), detailing the roles of a physician and 5 non-physician members of an interprofessional care team (physical therapy, social work, speech language pathology, pharmacy, and nutrition). For each profession, their training, common reasons for consultation, and common roles in the ambulatory setting were discussed.
Students then were divided up into 5 small groups by having them count off 1-5, with generally 7-11 students in each group. The IPW Director ensured that there was a uniform number of students from each profession within each small group to maximize learning and interaction. Each group rotated for 15 minutes through 5 small group profession-specific breakout sessions, each led by an IPW Facilitator who was a healthcare professional from each of the following 5 professions: Pharmacist, Physical Therapist, Registered Dietitian Nutritionist, Licensed Clinical Social Worker, and Speech Language Pathologist. During the profession-specific small group sessions, IPW Facilitators followed the same basic format: 1) they introduced themselves and described their role on the interprofessional healthcare team; 2) provided a demonstration of assessments or treatments they perform with patients in an interactive manner; 3) discussed how they would assist in the care of patients from the cases (Mr. S and Mrs. S, Appendix C. IPW Patient Cases); and 4) answered questions from student participants (See Appendix D. Guide to Profession-Specific Sessions).
After the small group breakout sessions, the IPW Director brought all student participants together as a large group to discuss lessons learned and complete the IPW Post-Workshop Survey (Appendix E). The IPW Director also surveyed the IPW Facilitators with the IPW Facilitator Survey (Appendix F).
Virtual Roles & Responsibilities Interprofessional Workshop
Prior to the Virtual IPW, workshop packets were created for all student participants which included all necessary supplies and handouts (see Appendix G. Virtual IPW Director Overview, Appendix K. Virtual IPW Handout – Medication Schedule, and Appendix I. Virtual IPW Welcome Letter). Students picked up their packets at designated locations and times prior to the workshop.
All participants were required to register for the workshop via Zoom. The Virtual IPW began with the IPW Pre Workshop Survey (Appendix E), followed by a 10-minute didactic presentation (Virtual IPW Didactic, Appendix H) given by the IPW Director (a physician), detailing literature about the benefits of the interprofessional care team. The cases of Mr. S and Mrs. S (Appendix C) were introduced, as were the role of the physician and what other professions would be participating in the virtual IPW.
Five 20-minute profession-specific sessions were then conducted by 1-2 IPW Presenters from each of the following 5 professions: pharmacist, registered dietitian nutritionist, speech language pathologist, physical therapist, and licensed clinical social worker. Each IPW Presenter followed the same basic format: they 1) introduced themselves and their role on the interprofessional healthcare team; 2) reviewed the required training for their profession; 3) discussed common roles on the interprofessional healthcare team; 4) discussed common reasons for consultation; 5) provided a demonstration of assessments or treatments they perform with patients; and 6) referred to the cases (Mr. S and Mrs. S, Appendix C. IPW Patient Cases).
Next, the breakout room function in Zoom was used to divide students into 15 small groups of approximately 10 students, with medical and pharmacy students evenly divided between the groups. IPW Small Group Facilitators were healthcare professionals from the 6 represented professions at the workshop. IPW Small Group Facilitators led the students through a series of discussion questions applying principles from the Virtual IPW to the cases of Mr. and Mrs. S (see Appendix J. Virtual IPW Small Group Facilitator Guide). Small group discussion lasted approximately 30 minutes. Breakout rooms were then closed, and a 15-minute question and answer session was held with the IPW Small Group Facilitators and Presenters. Participants were given time to complete the IPW Post Workshop Survey (Appendix E), and then participants were dismissed.
IPW Evaluation
Workshop participants were surveyed with optional IPW Pre and Post Workshop Surveys (Appendix E). The In-Person IPW utilized hard copy surveys printed on both sides of one paper; students were asked to complete the Pre Workshop Survey at the beginning of the session, hold onto the surveys until the end, and then complete the Post Workshop Survey at the close of the workshop. Virtual IPW Surveys were administered electronically via Research Electronic Data Capture (REDCap).9,10 REDCap is web-based software platform which securely captures data for research studies.
Both Pre and Post Workshop Surveys asked students to anonymously rate their own ability to carry out the 9 competencies from the Roles and Responsibilities domain of the Collaborative Practice Competencies3 (see Table) before and after the workshop on a 5-point Likert scale (1 = strongly disagree that they are competent, 5 = strongly agree that they are competent). Students were also asked to provide feedback on strengths of the workshop and how to improve the workshop. We used rapid cycle quality improvement in order to make small improvements to the workshop each year based on student feedback.
Statistical analysis was performed using SAS version 9.4. P-values were calculated using Wilcoxon signed rank test for difference (pre- and post-survey comparisons) and t-test for difference between groups (medical vs. pharmacy student comparison).
This study was deemed exempt by the Institutional Review Board of the University of Chicago Biological Sciences Division.
Results
The in-person IPW was conducted for three consecutive years (2017-2019), and the virtual IPW was conducted once in 2020.
Overall Results (In-Person & Virtual Combined)
A total of 469 students participated in the IPW (in-person and virtual) over a 4-year period; 336 students completed both the Pre- and Post-workshop surveys for an overall response rate of 72% (medical student response rate 284/372 (76%), pharmacy student response rate 45/97 (46%)). Ninety-three percent of students agreed that the IPW should be continued for future students.
Student self-rated abilities in each of the 9 Collaborative Practice Sub-competencies in the Roles/Responsibilities domain demonstrated a statistically significant increase for each sub-competency both when analyzing all students combined, as well as medical students alone and pharmacy students alone (see Figure). The greatest improvement in student self-rated ability was seen for sub-competency #4, “Explain the roles and responsibilities of other care providers and how the team works together to provide full care” (mean change 1.42 on 5-point Likert scale, p<0.0001.)
When comparing the change in medical student and pharmacy student self-rated ability to carry out the sub-competencies, there were 5 sub-competencies (RR3, RR4, RR5, RR6, and RR9) in which there were statistically significant differences in the change in medical student compared to pharmacy student responses (Figure 1). For these 5 sub-competencies, medical students demonstrated a significantly larger increase than pharmacy students.
Comparison of In-Person & Virtual IPW Results
A total of 321 students participated in the in-person IPWs; 259 students completed both the Pre- and Post-workshop surveys for an overall response rate of 81% (medical student response rate 230/282 (82%), pharmacy student response rate 22/39 (56%)). Ninety percent of students agreed that the in-person IPW should be continued for future students.
A total of 148 students participated in the virtual IPW; 77 students completed both the Pre- and Post-workshop surveys for an overall response rate of 52% (medical student response rate 54/90 (60%), pharmacy student response rate 23/58 (40%)). One-hundred percent of students agreed that the virtual IPW should be continued for future students.
For the in-person IPWs alone, students demonstrated statistically significant improvement in self-rated ability for all 9 roles/responsibilities sub-competencies with the greatest improvement again seen for sub-competency RR4 (mean change 1.45, p<0.0001).
For the virtual IPW alone, students demonstrated statistically significant improvement in self-rated ability for 8 of the 9 roles/responsibilities sub-competencies. Sub-competency RR2, “Recognize my limitations in skills, knowledge, and abilities,” showed an increase of 0.14 with a p-value of 0.051. When comparing the change in self-rated ability for the in-person (2017-2019) versus the virtual (2020) IPW, there was no statistically significant difference between them for 8 of the 9 sub-competencies. Sub-competency RR5, “Use the full scope of knowledge, skills, and abilities of available health professional and healthcare workers to provide care that is safe, timely, efficient, effective, and equitable,” showed a statistically significantly higher increase for the In-Person vs. the Virtual IPW; the mean improvement in self-rated ability was 1.30 for the In-Person IPWs, and 1.05 for the virtual IPW (p<0.02).
Qualitative Feedback
Students also provided qualitative feedback on the IPWs. When asked to list strengths of the In-Person IPW, students often mentioned the interactive nature of the small group sessions, the enthusiasm of the small group facilitators, the diversity of the professions represented, the question and answer nature of the small group sessions, and hearing directly from interprofessional providers themselves. When asked to name their top 3 strengths of the workshop, one student wrote, “Improving knowledge of scope of other health care providers. Appreciating the work of other care team members. Viewing other care team members as valuable and complementary to good outcomes.” Another student wrote, “I gained a better understanding of what other medical professionals do. I also learned how these professions view physicians.” Another student summarized their experience, “I felt that I gained a deeper understanding of various professionals' role in promoting patient health and well-being.” A large number of students from the latter years of the IPW felt the biggest strength was having students from another profession participate in the workshop with them. Students also commented about the small group setting: “I liked the small group format, it felt more relaxed, intimate, and allowed us to ask questions more easily.” Students also mentioned that they enjoyed getting up and moving to a different room for each small group session, since it kept them moving.
Students were also asked to provide ideas for ways to improve the In-Person IPW. During the first year of the workshop, students suggested incorporating more students from other professions, using a patient case, and making the small group sessions longer. Thus, after year 1, we invited other health professions students (nutrition trainees and social work students have been invited, but due to scheduling issues only pharmacy students have been able to join), we have incorporated the patient case, and small group sessions were increased from 10 minutes to 15 minutes each. Other feedback from students included more information on how IP healthcare team members communicate with each other, having more than 5 professions featured in the small group sessions (many students specifically suggested having physician assistants or nurses), having resources available online, having more direct interaction between medical and pharmacy students, including students from even more healthcare professions than just medicine and pharmacy, and making the small group sessions a bit longer and located in closer proximity to each other.
Students also provided qualitative feedback on the virtual IPW. Similar to the In-Person IPW, students appreciated the interactive nature of the workshop, despite being virtual, and the ability to work with students from another healthcare profession. Students also highly valued using the patient cases to provide concrete examples of how each profession may help patients. Students also mentioned that they felt it worked well as a virtual experience. When asked for how to improve the workshop, one theme that arose was that students wanted to learn more about how the various healthcare professionals communicate with each other. Some students also felt that it may be helpful to have more scheduled breaks.
The In-Person IPW Facilitators were also surveyed after each in-person workshop in which they participated. Each facilitator had participated in 1 to 7 IPWs over the three-year period of the In-Person IPWs. A total of 29 facilitator surveys have been distributed to IPW Facilitators, with a response rate of 76%. All facilitators agreed that 1) the IPW was a valuable session for the students; 2) students better understand the role of providers in their profession because of the IPW; 3) trainees in their own profession would benefit from participating in the IPW; 4) the format of the IPW was appropriate; and 5) they would be interested in participating in the IPW in the future. When asked for feedback on how to improve the IPW, many facilitators suggested attending each others’ sessions to learn more about their IP colleagues.
Discussion
The IPW is a high-yield, interactive educational experience that significantly advances pharmacy students’ and pre-clinical medical students’ self-rated competencies in the Collaborative Practice Competencies Roles/Responsibilities domain, most notably improving their ability to explain the roles and responsibilities of other care providers and how the team works together to provide care. Though all students demonstrated an increase in self-rated ability related to the 9 roles and responsibilities sub-competencies, medical students demonstrated a larger increase in all sub-competencies than pharmacy students. A possible contributor may be that medical students may have less exposure to IPE than other health professions. Another possible explanation may be that the pharmacy students were generally later in their training (third and fourth years) than medical students (first year). The medical students had very low baseline scores, leaving more room for improvement. This may be an indication that health professions students will benefit more from the IPW earlier in their training.
It is also notable that despite the need to adapt to a virtual format for the IPW in 2020, students still demonstrated statistically significant improvements in self-rated ability for 8 of the 9 sub-competencies. Furthermore, the degree of improvement did not differ significantly from prior in-person IPWs for 8 of the 9 sub-competencies. Thus this virtual format may be reliably used in various circumstances, such as when social distancing is necessary, if a large enough venue is not available for all participating students, or if students are not located in proximity to each other.
The IPW evaluation methods detailed above assessed participants’ and facilitators’ reaction to the IPW (Kirkpatrick Level 1).11 Surveys also asked participants to rate their own level of learning (Kirkpatrick Level 2) from the workshop.11 By repeating the evaluation for 4 consecutive years and by asking participants and facilitators for specific constructive feedback to improve the workshop we have been able to iteratively refine the workshop to reach its current form which is well-accepted by participants both in its format and its content.
Though many IPE interventions are described in the literature, this intervention is unique in that it is brief, high-yield and adaptable to an institution’s strengths and needs. As a half-day event, the IPW can fit into a busy curriculum and is ideal for institutions limited in the breadth of health professions students or professionals. The workshop structure is flexible enough in that it can be altered to accommodate health professions students and IPW Facilitators/Presenters based on availability of various professions at an individual institution. The grid at the end of Appendix D. Guide to Profession-Specific Sessions may be utilized to incorporate other health care professions in the workshop. For example, if an institution lacks access to a dietitian but has access to a respiratory therapist, a respiratory therapist can complete the grid in Appendix D to craft a small group session on respiratory therapy to replace that of the registered dietitian nutritionist. Similarly, if an institution lacks pharmacy students but has a PT school, then PT students could be participants in the workshop. Furthermore, when in-person learning is limited, whether due to infection control measures, such as during the COVID-19 public health emergency, or due to physical distance between participating health professions schools, the virtual version of this workshop can be utilized and still provide for effective interactive interprofessional collaboration between students.
Limitations of the IPW include the fact that though it can be generalizable to any healthcare professions student, it is most directly applicable to medical students since the majority of the participants to date have been medical students. Furthermore, due to a paucity of other schools of healthcare professions at our institution, and the limited schedules of neighboring schools, we have not been able to pilot the IPW with students other than medical and pharmacy students to obtain their feedback.
Another limitation is related to the length of the IPW. Several participants suggested lengthening the time for each small group session, and increasing the number of healthcare professions represented. However, this would significantly lengthen the IPW, and given curricular constraints we have only been able to devote a half-day session to the IPW at this time. As noted above, several students requested having nurses or physician assistants as IPW Facilitators; the medical students at our institution do have other IPE activities later in the curriculum in which they work with these professions, which is why we have not added these professions to the IPW.
One final limitation of the IPW is the focus on only 1 of the 4 Collaborative Practice Competency domains, Roles/Responsibilities. Some participants commented on the desire to have the IPW focus more on communication strategies. However, our medical students do have other IPE activities during years 2 through 4 of medical school which focus on the other competency domains: Values/Ethics for IP Practice, IP Communication, and Teams and Teamwork.3 We felt that the priority for first-year medical students was to develop a strong foundation in the Roles/Responsibilities domain which they will build on later in their medical school careers. This Roles/Responsibilities IPW is meant to be only one introductory component of a longitudinal interprofessional educational curriculum.
In future years, we plan to continue to incorporate participant and facilitator feedback to continue to improve the IPW. We will have pharmacy students participate earlier in their training to better match the level of the medical students and maximize learning opportunities. We will work with other healthcare professions who have rotating students at the institution to incorporate students from other healthcare professions. We will also partner with other neighboring institutions that have a larger variety of healthcare professions students to participate in the IPW.
In summary, this is a brief IPW that effectively teaches the Collaborative Practice Competencies Roles/Responsibilities domain. It is innovative in its brevity and adaptability to a variety of formats and situations.
Disclosures
TK, LK, WM, and JC and this publication are supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award (K02HP30823) totaling $991,297 with 0 percentage financed with non-governmental sources. KT is the director of the SHARE Network, supported by HRSA of the U.S. Department of HHS under grant number U1QHP28728. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
JC receives a stipend from the Veterans Administration Endocrinology Scientific Review Group.
VP receives consulting fees for Humana and Vizient, and research funding from NIH, American Lung Association, and American Medical Association.
Appendices
- In-person IPW Director Overview.pdf
- In-Person IPW Didactic.pptx
- IPW Patient Cases.pdf
- Guide to IPW Profession-Specific Sessions.pdf
- IPW Student Pre and Post Workshop Surveys.pdf
- IPW Facilitator Survey.pdf
- Virtual IPW Director Overview.pdf
- Virtual IPW Didactic.pptx
- Virtual IPW Welcome Letter.docx
- Virtual IPW Small Group Facilitator Guide.pdf
- Virtual IPW Handout -- Medication Schedule.pdf
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