Improving Interdisciplinary Collaboration in First-year Health Professional Students through a Learner-Developed and Learner-Driven IPE Curriculum
|9284||December 10, 2012||1|
In 2006, UCSF began implementing an interprofessional health education (IPE) curriculum for all 475 first-year learners across the five UCSF health professional programs (Dentistry, Medicine, Nursing, Pharmacy, and Physical Therapy). Each year, the curriculum has been further refined based on feedback, evaluations and IPE literature review. This task, as well as implementation and evaluation of the curriculum, was largely undertaken by a group of second- and third-year professional students from the schools of pharmacy, dentistry, medicine, and nursing.
The 2011-12 curriculum is based upon selected competencies from the Interprofessional Education Collaborative (IPEC) report from May 2011. The competencies selected were deemed appropriate and achievable for first-year learners. From these competencies, learning objectives were created for each component of the curriculum. Furthermore, activities were developed that would allow learners to achieve these learning objectives through attendance, participation and interaction at planned curricular events.
This IPE curriculum consists of three components: 2 organized half-day exercises (referred to as Day 1 and Day 2) and a yearlong longitudinal community-based project. For each of these components, first-year learners from each of the professional schools were divided into groups of 7 to 8 interprofessional students (referred to as “pods”), for a total of 60 interprofessional pods. Students remained in the same pods (i.e. with the same group of students) for the entire yearlong curriculum. Due to the differing numbers of students in each program, this allowed for 2-3 medical students, 2-3 pharmacy students, 1-2 nursing students, 1-2 dentistry students, and 0-1 physical therapy students in each group.
Day 1 occurs in the fall quarter and is a 3-hour event in the campus gymnasium with all 475 first-year students, the Deans, several faculty members, and representatives from Student Life Services. Day 1 focuses on a standardized patient monologue and skit, a health policy discussion and the roles and responsibilities of the health professions. First-year learners prepare in advance of the event with required reading of one of four health policy “hot” topics: accountable care organizations, health insurance reform, Healthy San Francisco, and provider shortages. These topics were developed into one-page fact sheets as a means to introduce learners to the subject and to generate discussion during the event. Day 1 begins with a standardized patient actress presenting a monologue of her struggles with the health system. Students, arranged into the pre-assigned interprofessional pods, discuss the patient’s situation and how the prepared health policy topics apply to this patient situation. After the policy discussion, the Deans of each of the UCSF professional programs meet and interview the patient, acting in their respective provider roles. Following this skit, the pods reconvene as a team to discuss the patient’s plan of care.
At the end of the Day 1 presentation, the first-year learners are introduced to the longitudinal project component. The longitudinal projects are community-based projects for which organizations and clinics in the San Francisco Bay area expressed a need for assistance. Representative examples of longitudinal projects include development of tobacco cessation social media, needle exchange program awareness and education materials, development of a needs-based curriculum focused on nutritional education deficits of local high school student, and conducting a study on animal-assisted therapy amongst many others. The project guidelines require each student to commit 10 hours over the course of the year to meeting and working on the project. Twice per quarter, the first-year learners submit project check-ins to the course website, describing their project, roles and responsibilities of team members, and progress updates. Following these submissions, feedback was provided by the student coordinators. The projects were due for upload to the course website in the spring quarter and were graded using a pre-designed assessment rubric.
Day 2 occurs during the winter quarter and focuses on a patient case discussion in small breakout rooms throughout the campus. One or two of the interprofessional pods are assigned to a room with a facilitator. At the start of the event, students introduce themselves and discuss their current curricula and the coursework they look forward to in the future. Following this discussion, students complete a short roles and responsibilities survey adapted from an exercise created by the Wisconsin Area Health Education Center. The survey instructs students to indicate with a check mark which profession(s) perform(s) common patient care activities. The learners review their answers and discuss any differences arising from this roles and responsibilities exercise. This activity leads into a case-based scenario that is a continuance of the Day 1 patient case. The case is reintroduced to the learners who then work together to prioritize the patient’s health needs, identify professions who can meet these needs, and develop a rough patient care plan. Learners then identify and discuss barriers to interprofessional collaboration at their institution and in providing care to this patient, and brainstorm how the curricula need to change in order to prepare them to work with this patient as a team. The day closes with a team-debriefing discussion of their progress on their longitudinal projects and completion of the Day 2 survey.
Days 1 and 2 are evaluated with a post-event survey, which includes items with Likert-scale responses and open-ended questions for comments on the best aspect of each event and how the event could be improved in the future. The curriculum is also evaluated with a pre- and post-curriculum competency assessment tool created by the interprofessional student leaders based on the IPEC 2011 competencies.
Colley P, Cai J, Ofshteyn A, Purcell M, Brock T, Courey R, Hyde S. Improving Interdisciplinary Collaboration in First-year Health Professional Students through a Learner-Developed and Learner-Driven IPE Curriculum. MedEdPORTAL Publications; 2012. Available from: https://www.mededportal.org/adea/publication/9284 http://dx.doi.org/10.15766/mep_2374-8265.9284
- To describe the roles of dentistry, medicine, pharmacy, nursing and physical therapy in providing patient-centered and population-oriented care.
- To engage in discussion with other health professional students on the role of the interprofessional team in the 2010 Affordable Care Act (ACA), with a focus on accountable care organizations, provider shortages, health insurance reform, Healthy San Francisco and the patient-centered Medical Home Model.
- To explain the role of Interprofessional Health Education in the health professional curricula as it relates to interprofessional practice in the health system workforce.
- To practice being receptive to and eliciting opinions from members of the interprofessional team in a patient-centered fashion.
- To work with other health professional students to create a comprehensive care plan for a patient.
- To communicate information, one’s professional identity, unique skills and opinions in a manner that is patient-centered, not discipline specific and engages the interprofessional team.
- To describe how other health professional school curricula complement and differ from each other, in relation to how these professions can work together as an interdisciplinary team in practice.
- To integrate knowledge and experience of other health professions and collaborate with a team of health professional students on a project of their choosing.
- To communicate, organize and listen actively with a team of health professional students.
- First-Year Learner, Small Group Discussion, Teamwork, Interprofessional Education Collaboration (IPEC)
Endocrinology, Diabetes & Metabolism
- Endocrinology, Diabetes & Metabolism
- Public Health
- Internal Medicine
- Critical Thinking
Interpersonal & Communication Skills
Knowledge for Practice
Practice-based Learning & Improvement
Team-based Learning (TBL)
Allied Health Student
- Allied Health Student
Authors & Co-Authors
Peter Colley, BS, BA
University of California - San Francisco, School of Pharmacy
University of California - San Francisco, School of Dentistry
Maura Purcell, RN
University of California - San Francisco, School of Nursing
Renee Courey, PhD
University of California - San Francisco, School of Medicine
University of California - San Francisco, School of Medicine
Tina Marie Penick Brock, BS, BA, MS, EdD
University of California - San Francisco, School of Pharmacy
Susan Hyde, DDS, MPH, PhD
University of California - San Francisco, School of Dentistry
Sponsorship or Funding Source
Funded in part by the Josiah Macy Jr. Foundation in fulfillment of the AAMC/IPEC interprofessional education initiative.
Effectiveness and Significance
Student feedback from the post-Day 1 event surveys (N = 434) showed that 80% of students agreed the interactive patient case scenario between the Deans and standardized patient helped their understanding of the roles and responsibilities of the health professions. 88% of students agreed that the health policy topics discussed were interesting. Furthermore, 77% of students agreed that Day 1 was an effective session overall and 78% of students agreed that Day 1 complemented their education.
Student feedback from the post-Day 2 event surveys (N = 430) showed that 89% of students agreed the patient case required the perspective of all group members. 81% of students agreed that working with a team on a patient case was useful to their education and 92% agreed that the small group discussion setting helped students to engage with others effectively. There was greater variation in students’ agreement towards the amount of time allocated to each activity, with several students commenting more time should be allocated to discussing each other’s curricula. 86% of students agreed (50% strongly agreed) that the discussion of other school’s curricula was useful in showing students what other health professionals learn. In fact, in the free response section of the survey this activity was identified by many students as one of the best aspects of the event. Finally, 73% of students agreed that the IPE Day 2 experience complemented their professional education and 75% felt overall it was an effective session.
Previous iterations of the IPE curricula measured outcomes using the Readiness of Interprofessional Learning Scale (RIPLS) and the Interdisciplinary Education Perception scale (IEPS). These survey tools did not possess the discriminative properties necessary to detect learner outcomes, as students scored high pre-curriculum and scored at the same level or less post-curriculum (ceiling effect). The preliminary data from the new IPEC-based competency assessment tool were promising, as outlined below.
Data from the pre-curriculum survey suggests greater efficacy of the new assessment tool for capturing learner pre-curriculum self-appraisal of IPE competencies. The mean for self-assessment of IPE competencies on the pre-survey was found to be lower than the responses to previous years’ RIPLS and IEPS surveys. Also the standard deviation for most responses indicates greater variation in the levels of learner confidence in IPE competencies.
The analysis of the pre- and post-assessment survey showed that students moved closer toward achievement of the interprofessional competencies chosen from the IPEC 2011 report. Variations in the competencies achieved were noted between programs. Improvement in competencies was defined to be a positive change of greater than 5% in students’ level of agreement to survey items between the pre- and post-survey. A detailed statistical analysis on the effectiveness and significance of this pre- and post-survey tool is currently in progress.
Medical students (N = 33) showed improvement in the IPEC competency domains of communication, roles and responsibilities and teamwork. These items related to students’ ability to describe the roles and responsibilities of the interprofessional team, integrating knowledge of other health professions to inform care decisions, and communicating a clear message to other professionals without using profession-specific language.
Masters Entry Program in Nursing (MEPN) students (N = 21) showed improvement in the IPEC competency domains of communication, roles and responsibilities and teamwork. These items related to competencies of students to describe the roles and responsibilities of the interprofessional team, being cognizant of their use of profession-specific terminology, and the importance of working as an interprofessional team.
Physical therapy students (N = 7) showed improvement in the IPEC competency domains of roles and responsibilities, values and ethics, and teamwork. These items related to students’ ability to describe the roles and responsibilities of members of the interprofessional team and their ability to integrate knowledge of other health professionals to inform care decisions.
Improvement in the IPEC competency domains for pharmacy and dental students was less pronounced than the other three professions. Interestingly at the time of the post-survey, Dentistry students (N = 12) agreed more with the statement that their contributions are valuable to the interprofessional team, yet agreed less to statements related to the necessity of working as an interprofessional team and understanding the importance of building relationships with other professions. Pharmacy students (N = 27) improved on items related to students’ ability to describe the roles and responsibilities of the interprofessional team. However, these students scored similarly to dental students on the remaining items.
Overall, there was little or negative change in many of the items related to the Values and Ethics competencies across all the professions. This negative change may be due to recency effects (i.e. the post-survey was sent approximately 7 months after Day 1 and 4 months after Day 2) and the fact that the survey was linked to the student evaluation of the longitudinal project, a component of the curriculum where students showed the most unrest.
These results give usable data to further improve the curriculum in future years that was not possible when using the RIPLS and IEPS surveys. Specifically, the curriculum can be altered to better focus on the competencies related to the Values and Ethics domain. The difference in which profession improved in which competencies may be a result of culture differences within each profession and perceived differences in the amount of interprofessional collaboration that occurs in practice for each profession. In other words, students may perceive that some professions may require more interprofessional collaboration than others.
The longitudinal project showed mixed results. For the most part, students liked being in the same group of 8 students throughout the curriculum as it provided continuity. While overall students seemed to perform well on the longitudinal project, the appeal of the project to students was fairly low. The project has since been repurposed into a different longitudinal activity that still spans the entire year. The main issue with the project seemed to be finding a time across students’ schedules to meet and work on the materials. Students reported they would much rather have times set aside for them to work on the project rather than find time on their own. Many students set up online methods of collaboration, such as Google documents, to complete their projects instead of meeting in person. Furthermore, since the projects ranged from different community organizations to university faculty mentored projects, there was a large difference in the quality of mentorship with completing the project. Those projects with faculty members as mentors performed better overall.
Special Implementation Guidelines or Requirements
This IPE curriculum requires many additional faculty and volunteers to facilitate the two IPE events. These individuals are required to attend an orientation and calibration workshop in order to minimize any potential confusion regarding the objectives of the sessions and their roles in facilitation. Leadership from each of the disciplines is crucial to underscoring the importance of each event.
Regarding the community-based longitudinal projects, the course director needs to contact fellow faculty, local hospitals, clinics, health organizations, and schools to recruit projects for the students. This preparatory work needs to be done well in advance such that once the curriculum starts, the students can sign up for a project they are interested in and be grouped accordingly. This should facilitate group dynamics since all of the students within the group have expressed interest in the project.
Space requirements are important for each event and depend on the size and number of professional programs involved. The Day 1 event requires a large space capable of fitting all first-year individuals, such as a gymnasium, auditorium, or outside seating space. Day 2 requires ~40 classrooms or conference rooms with a seating capacity of 9 to 17 individuals (1-2 groups plus 1 facilitator). The student groups on Days 1,2 and the Longitudinal Project are comprised of the same members in order to provide continuity and a safe place for communication. The rooms are reserved for an additional hour after Day 2 ends to allow students a place to work on their longitudinal projects, if desired.
Technology resources for Day 1 implementation are a huge component to its success. The space must be set up with chairs for all students, grouped in pods, at least 2 hours pre-event. There may also be needs for projection devices for PowerPoint and live video of the stage, microphones (wired and/or wireless), speaker systems and proper stage lighting if necessary. A course website is a necessity to release student materials and provide discussion forums for students to report their progress on their projects.
Technology needs for Day 2 are much less, and most materials can be released to students pre-event via the IPE course website. Facilitators for Day 2 are instructed to sign in at a designated location before heading to their assigned rooms. At sign-in, each facilitator is provided with a packet of materials that includes a detailed schedule, a description of each activity, as well as a time keeping sheet. Facilitators are also given suggested answers for the patient case to guide discussion. Finally, each facilitator is provided with the facilitator training session PowerPoint to remind them of the purpose and structure of the session. Post-Day 2, facilitators are instructed to return to the sign-in location to return the team debriefing and all student evaluations.
Support and buy-in from faculty and deans from each of the Schools as well as university leadership are needed for a successful event. Representatives from Student Life Services and the Office of Careers and Professional Development (OCPD) or similar organizations are equally important in planning the logistics of the event. Prior to Day 1, an informational session was presented to each of the Schools to explain the IPE curriculum components, its significance, and to generate excitement around the curriculum. Student Life Services planned a social event after Day 1 and were crucial in collecting evaluations. OCPD helped in tracking attendance with an iPad-based system that registered identification from student badges. Implementing the curriculum also highlighted the importance of accountability, responsibility, and flexibility, which are all required qualities when working on an interprofessional team, whether it is an interprofessional health care team or interprofessional curriculum development team. Differing structures and schedules (including exam schedules) of each professional program often limit time for interaction. This fact has been a major barrier to the longitudinal project, as students often reported difficulties finding optimal times for all members to meet. Students reported they would much prefer to have time set aside in the curricula to complete their projects instead of trying to find the time on their own. Strategies have now been adopted to ensure this time is allocated. Different programs also start their first year at different times, especially with respect to clinical work. Specifically, nursing and physical therapy had already started their clinical work whereas dentistry, medicine, and pharmacy had not. This fact may change the perceptions of the different professional programs toward interprofessional education.
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