True interprofessional education doesn’t just happen; it takes planning.
How does one acquire interprofessional educator skills? For the author, it came in the form of a collaborative learning experience with three veterinary medicine professors.
Key recommendations of the 2010 report The Future of Nursing: Leading Change, Advancing Health focused on the importance of developing leadership and improving interprofessional (IP) collaboration. Concurrent with the profession’s implementation of these recommendations, improvements in technology and access to information via the internet have generated a new wave of students desiring active engagement and creative learning opportunities in the classroom. To that end, interprofessional problem-solving experiences are being incorporated into nursing classrooms—sometimes without the science, knowledge, or experience needed to promote meaningful learning.
I am from a generation of nursing students who built personal libraries populated with large textbooks heavy not only in weight but also in content—massively detailed content about body systems, pathology, nursing diagnoses, and standardized care plans. Sitting in large lecture halls, my peers and I listened to professors, viewed overhead projector presentations, and took copious notes that repeated information contained in our textbooks.
There was very little problem-based learning in the classroom. Our nursing classes never included students who were preparing for careers in other healthcare professions. Only in clinical settings did nursing students practice skills and apply knowledge. Physicians were captains of the ship, and sometimes nursing duties included making coffee for the captain’s morning rounds.
With time, those of us in clinical nursing came to realize that great nursing care is more than technical details published in textbooks or observance of hierarchical practices. As nursing expanded its academic reach through the work of nursing theorists such as Patricia Benner, nursing gained new respect and attention and became an equal partner in the planning and delivery of healthcare.
Eventually, master’s-level prelicensure nursing programs were developed and condensed into one to two years of learning, and educators were faced with—and are still faced with—the challenge of producing qualified nurses who are critical thinkers, respected leaders, and effective team members within a multiprofessional and complex healthcare system. How do we do it?
Opportunity knocks
For me, the opportunity to acquire needed IP educator skills came when I was chosen for a nine-month fellowship for “interprofessional teaching scholars” at the University of California, Davis. Each year, the fellowship is awarded to about a dozen faculty educators from medicine, nursing, pharmacology, and veterinary medicine. Fellows meet weekly to learn about theory and best practices for educators in the health sciences. The program, which focuses on active learning and interprofessional education (IPE), culminates with completion of a relevant IPE project.
I had the good fortune of being part of a group that included four professors from the University of California, Davis School of Veterinary Medicine. Three of them agreed to work with me in creating a pilot IPE session for veterinary medicine students and master’s level prelicensure nursing students.
Together, we scoured the literature to identify best practices and match students appropriately for best outcomes. We were generally unsuccessful in finding suitable IPE examples in the literature that could be used as a template for teaching combined classes of veterinary medicine and nursing students. There were, however, examples of medical students and veterinary medicine students working together on the topic of cross-species infections. We also determined there would be benefit in student evaluation of such a seminar, and we identified relevant tools from the literature.
Getting the OK
The next step was to secure approval from both schools to create the educational experience we envisioned—a one-day, eight-hour interprofessional seminar. One challenge was dealing with diverse institutional environments and the resulting issues: integrating students from semester systems with students from quarter systems, incorporating new course material into pre-existing and accredited curricula, and finding appropriate technology for students to access and share information. Another challenge was overcoming concerns about disrupting existing programs and violating what are considered appropriate curricular workloads for students.
We overcame hurdles by identifying the proposed experience as a one-time pilot and by carving out time within each program’s existing classes. For example, nursing students were provided release time from their collaborative practice course and received credit from the new program toward their final collaborative practice grade. Veterinary medicine students received one unit of elective credit. To overcome the technology hurdle, we agreed upon a learning management system that could be used by both students and faculty to access and share information.
Because the university’s School of Health Sciences and School of Veterinary Medicine are 20 miles apart, we agreed to use the veterinary site so that, at the end of the formal seminar experience, nursing students could tour the veterinary school’s nationally recognized animal hospital. Because the high quality healthcare the animals receive is superior to what many humans are able to access, conversations about social justice and equity were an unanticipated benefit.
The experience
A true IPE experience is not simply about placing students from different educational tracks together and lecturing them on the same topic, nor is it about inviting guest speakers from different disciplines to provide content-heavy lectures. Developing meaningful IPE experiences requires careful collaborative planning by interprofessional faculty instructors.
My veterinary colleagues and I found that our discussions and seminar planning were rewarding, enlightening, and fun, and we concluded that our example of interprofessional teamwork served as an effective and valuable role model for our students. Our collaborative approach also helped ensure that both groups of learners—veterinary medicine students and nursing students—benefited equally from the experience.
We designed the eight-hour session from a curriculum development perspective. Each member of the team was responsible for different deliverables, e.g., establishing the agenda, planning specific sessions, selecting faculty facilitators, obtaining required classroom materials, arranging for small-group breakout rooms, and identifying appropriate presession readings. (Students were required to read selected materials in preparation for the seminar.) The class was divided into four two-hour segments, each with unique topics. A catered lunch was arranged to give students an opportunity to socialize.
Throughout the process, we maintained constant communication via a secure file-sharing system, emails, and phone conferencing, and the day before going “live,” we practiced to work out the bugs and ensure everything fit into the planned timeline. The full group of interprofessional teaching scholars—the fellows—and curriculum administrators in both schools reviewed the final seminar plan.
In addition to the two-hour topical segments, faculty from veterinary medicine and nursing made short presentations to the overall group, demonstrating a collaborative approach to teaching the topical content. Following these presentations, students were divided into smaller groups composed of both veterinary medicine and nursing students to grapple with an unfolding story about an older man and his elderly dog that focused on issues related to dementia, isolation, cross-species zoonotic infection, assessment and management of pain in nonverbal mammals, therapeutic benefits of the human-animal bond, grief, loss, and dying.
Faculty facilitators from both veterinary medicine and nursing led each of these groups, and students learned about their roles and responsibilities as healthcare providers—how they were similar and how they were different—as they tackled various aspects of the case. In doing so, they had the opportunity to expand their thinking beyond their chosen professions. After completing the small-group, tabletop exercise, everyone was brought back to the larger group to present key discussion points. The conversations were provocative, deeply reflective, and rewarding.
Assessment
Quizzes and evaluation surveys were used to assess the interprofessional experience, and nursing students were assigned, as part of their course grade, to write a reflective journal entry about the experience. Overall, the students seemed to appreciate the opportunity to interact across disciplines, with one commenting that it was the best experience she had had to date in the nursing program. Feedback requested of faculty instructors was also generally positive.
Although we were gratified by the positive student evaluations, several ongoing challenges and questions remain. For example, my colleagues and I continue to struggle with how to determine if interprofessional education experiences such as the one we designed translate into application in the clinical arena and lead to improvement in IP team functioning. Another challenge is trying to create curricular flexibility that allows students from a variety of professions and programs to engage in these experiences. I believe solutions to these challenges lie in 1) tracking students longitudinally as they move from novice to expert in the clinical setting and 2) building administrative support for programs that give more than lip service to providing vibrant and meaningful interprofessional education experiences. RNL
Susan L. Adams, PhD, RN, NP, CNS, is assistant clinical professor at the Betty Irene Moore School of Nursing at the University of California, Davis in Sacramento, California, USA.
Editor’s note:
Susan Adams will present “What Can Graduate Master’s Entry Nursing Students and Veterinary Medicine Students Learn From Each Other?” on Sunday, 22 July 2018, at Sigma’s 29th International Nursing Research Congress in Melbourne, Australia. Register here for congress.
Check out these additional articles by presenters at the 29th International Nursing Research Congress.