InTICE: Innovative Transitional Inter-professional Clinical Education

P. Basaviah, MD; H.C. Chen, MD, MSEd; S. Khayam-Bashi, MD; R. Plank, RN, PhD; S. Youmans, PharmD, MPH(c)
University of California, San Francisco Schools of Medicine, Nursing, and Pharmacy

Introduction

• Successful collaboration among health care professionals optimizes patient outcomes
• In 1966 the Primary Care Education and Clinical Training task force identified that collaborative efforts in training and education should occur between the four professional schools housed at UCSF
• Focus groups provided data demonstrating significant overlap in curricula and clinical experiences in Dentistry, Medicine, Nursing, and Pharmacy
• While some inter-professional programs exist at UCSF, significant collaboration in basic core curricula is absent

Hypothesis

Training in collaborative patient care through classroom and clinical settings will facilitate inter-professional teamwork and result in improved patient safety and outcomes

Proposal

The UCSF-Macy Inter-professional Team proposes an  inter-professional curricular program which brings together students in the Schools of Medicine, Nursing and Pharmacy

Program Objectives

Cultivate collaborative work and learning models early in training of students in medicine, nursing and pharmacy. Essential themes include:

• Promoting respect and understanding of pivotal roles of various professionals involved in patient care
• Providing multi-disciplinary foundation for clinical training that reflects the current world of health care
• Cultivating early in professional education the recognition of need for an inter-professional approach and team collaboration in health care delivery

Program Description

• Five discrete curricular modules
• Flexible implementation in longitudinal fashion by each of the three professional schools
• Modules designed to be stand-alone educational units
• The sequence builds upon each prior unit, addressing increasingly complex issues
• Opportunities for inter-professional collaboration through small group discussions, clinical training, and role-play scenarios will be integrated

Fig. 1. Classroom participation in a “mock” setting by students in multiple health related professions prepare them for actual patient interventions in the health system setting ©Robert Foothorap.

Table: Inter-professional Curricular Modules

Module I          Delineation of various health care professional roles

Example           Fig. 2:  Danovic case, in-class role play, inter-professional small group discussions (year 1 training)

Module II         Exposure to collaborative care in the inpatient setting

Example           Shadowing experiences on inpatient teams with inter-disciplinary care as focus (year 1 or 2)

Module III        Patients’ perspectives on collaborative care

Example           Standardized patient scenarios, discharge plan (transition to clinical training)

Module IV       Working effectively as a team

Example           Patient simulation (clinical training - early)

Module V         Team problem solving

Example           Patient simulation – when things go wrong, how to collaboratively troubleshoot (clinical training - mid)

Fig. 2. In-classroom emergent care interprofessional training using the “Danovic Case” ©Robert Foothorap.

Evaluation Plan

Learner Assessment

• Pre and post-intervention inventories measuring attitudes toward physician-nurse-pharmacist collaboration
  • Attitude inventories are modified versions of the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration
• School of Medicine clerkship evaluation question modified to assess student ability to work with other health care professionals
• Objective Structures Clinical Exam (OSCE) station to measure student ability to engage in inter-professional collaboration
  • An addition to pre-existing School of Medicine and Nursing OSCE student assessment programs
  • Part of new OSCE program in School of Pharmacy

Program Evaluation

• Student evaluations of modules’ efficacy
• Faculty evaluations of modules’ efficacy
• Learner outcomes as measured by the learner assessment methods listed above

Implementation Plan

• Focus groups with patients, students, and faculty to collect “real world” experiences for basis of curricular materials
• Development of curricular modules
• Implementation of modules I, II, and III across all three schools by Fall 2006

Current Progress and Challenges

• Support (non-financial) obtained from the UCSF inter-professional task force
• Support (non-financial) obtained from Dean’s Offices of all three schools
• Ongoing curriculum development, with Modules I and II partially developed using components of existing curricula
• Grant submitted to help fund creation of instructional materials for Module III
• Ongoing search for funds to support faculty time for curriculum development and implementation

Key Reference

Mitchell, P.H., Crittenden, R. A. Fall 2000. Interdisciplinary collaboration: Old ideas with new urgency. Washington Public Health. University of Washington School of Public Health and Community Medicine.

Taylor, D. & Wade E. (2002). UCSF center for collaborative primary care. San Francisco: UC Regents (University Publications #4627)