Agents of C.A.R.E.
Health care disciplines team up through interprofessional education (IPE) to tackle the challenges of the future.
Today’s health care challenges are more complicated than ever. We now know more about who and what we are than at any point in our history. And with that knowledge comes power. Power to heal more effectively, power to deliver care more efficiently, and power to adapt treatment so that patients are healed on their own terms.
And if we have learned anything, it’s that great power comes with great responsibility.
Ohio Northern University is working to harness the power of four distinct academic programs —pharmacy, nursing, exercise physiology and medical laboratory science — into a single health care alliance under a new interprofessional education (IPE) program implemented this year. These disciplines are formative on their own, but joined together form a life-saving force of blockbuster proportions.
Interprofessional teamwork, as it is known in the field, has been shown to produce startling results. According to the Academic Health Center at the University of Minnesota, interprofessional teamwork is responsible for improved health care experiences, 50 percent reductions in both adverse patient outcomes and the length of the average ICU stay, a dramatic decrease in the clinical error rate, and lowering the per capita cost of health care, all while increasing in the professional satisfaction of those employed in health care fields.
ONU’s IPE program is an introduction to interprofessional teamwork for students who will likely be exposed to it in their careers. The program is a problem-based, cross-disciplinary approach to allied health education developed by ONU faculty members Susan Montenery, assistant professor of nursing; Natalie DiPietro, associate professor of pharmacy practice; Michelle Musser, assistant professor of pharmacy practice; Lisa Walden, assistant professor of medical laboratory sciences; and Sara Terrell, assistant professor of exercise physiology. The group received important feedback from fourth year pharmacy student Adam Smith, who provided a student perspective during program development. Additional program objectives include providing opportunities for students to work collaboratively to solve cultural health care cases, exposing students to other health care disciplines, improving curricular connectivity, and fostering team-based communication and decision-making.
“Exposure to IPE within undergraduate settings presents opportunities for students to practice skills necessary for successful patient-centered, team-oriented treatment,” says Terrell.
ONU’s IPE program organizes students from the four disciplines into teams of eight or nine. Based on enrollment in those programs, a typical group comprises five pharmacy students, up to two nursing students, up to two exercise physiology students and one medical laboratory science student. Each group is assigned a medical care scenario to which they must provide plans for both assessment and recommendation of treatment.
To aid in the University’s mission of preparing students to “act as ethical and responsible members of a global community,” each IPE scenario presents a unique cultural detail to further expand the educational value of the exercise by increasing cultural competency.
In their coursework, students learn the proper steps and procedures for delivering care based on patient symptoms and biological metrics among other measurable data. At the most basic level, health care loosely follows the formula if x then y. The cultural details within the IPE scenarios introduce new variables to that equation. Students must rely on the breadth of their knowledge, and one another, to treat patients who for religious, cultural or socioeconomic reasons cannot receive the most practical manner of care.
In one scenario, students were asked to figure out a way to help a young Muslim woman continue her medication regimen during the holy month of Ramadan, when Muslims are required to fast. In another, students had to help a stroke patient whose religion prohibited him from receiving any medical care. As the obvious answers were stripped away, students thought harder and sought solutions farther outside the box.
“Due to our patient’s cultural beliefs, certain treatments weren’t an option. As professionals, it is still our responsibility to make the patient aware of the benefits of certain treatment plans, and of the harmful effects that could arise due to not partaking in them,” says Kaitlyn Theisen, a junior exercise physiology major from Saranac, Mich. “It also forces us to come up with alternate treatment plans that better take into account their cultural beliefs. All we can do is make sure they have all the information in regards to treatment options. Ultimately, it is their decision.”
While the case studies were designed to force the issue of cultural competency, the lessons students learned during the exercise reinforced best practices for interaction with all patients, not just those in which cultural differences are apparent. The faculty intentionally included many open-ended questions in the case studies to get students to explore as many options for assessment and treatment as possible. For example, they asked students to consider why a patient might refuse a medication choice and if there is alternative that they could suggest. Also, should their medical advice go unheeded, what education and counseling could they give their patient to see that some improvement in his or her condition still occurs?
“Having a nursing course specifically geared towards cross-cultural care definitely quickened my thought process on what interventions would and would not work for each patient,” says Ellis Pohlman, a junior nursing student from Maria Stein, Ohio. “It is important to ask every patient their cultural background and preferences to help build a care plan that will work best for them.”
As much as the faculty behind IPE wanted the students to interact with one another and apply their knowledge toward a common goal, they also want to make sure that the manner in which they are providing this experience actually worked. From the very start, they designed the IPE to be both an active participatory learning experience and a research project.
Before beginning the IPE program, the faculty assessed 225 students’ readiness for interprofessional learning upon a validated scale. According to Terrell, this kind of project isn’t typically done with undergraduate students, so it is vital to have evidence to support that ONU students are more than capable of such an advanced exercise. The program itself included two group problem-solving sessions and a follow-up session during which the groups shared their results. After the program, students were reassessed with the same questions. While the hard data is still being processed, the faculty group has already been accepted to present at an academic conference this summer. The early results are certainly positive.
According to the results, 43.6 percent of students “agreed” and 48.6 percent “strongly agreed” that participation in the IPE activity improved their understanding of what other health care-related disciplines do and their role in patient care. Nearly 50 percent “agreed” and 41.5 percent “strongly agreed” on the post-activity assessment that the activity had made them more aware of cultural competency principles and its importance in patient care.
This interdisciplinary collaboration may serve as a starting point for future discussions on enhanced IPE integration within health care curriculum. As it stands currently, IPE is a supplemental component to existing courses within the disciplines — EXPH 3301 Exercise Management of Chronic Disease and Disability, NURS 3301 Transcultural Health Care, PHPR 3011 Profession of Pharmacy 5, and MLS 4611 Professional Practice and Development.
“I think where we would like to see this go is to where IPE becomes more than a few exercises within a class,” says Terrell. “I see it as crucial to shaping our curriculum in the future.”
Additional IPE activities are currently in progress. On March 26 and April 2 pharmacy students (P5) and senior nursing students (NURS 4981-Transition to Professional Practice) will be collaboratively completing complex case studies using the same assessment criteria. To learn more about IPE at Ohio Northern, please contact Natalie DePietro.