⏐ FIELD ACTION REPORT ⏐
Enhancing Interprofessional Education: Integrating Public Health and Social Work Perspectives | Cheryl L. Addy, PhD, Teri Browne, PhD, Elizabeth W. Blake, PharmD, Jennifer Bailey, MEd
National stakeholders in health system improvement and patient safety including accreditation bodies have requested health professional educational programs to include multiple interprofessional experiences through didactic and experiential opportunities. Clinical and population health faculty at the University of South Carolina redesigned and expanded an introductory interprofessional course to include more than 500 students from public health, social work, medicine, pharmacy, and nursing. Students participated in 3 live class meetings and completed required online coursework to explore concepts related to social determinants of health and health disparities, health system improvement, patient safety, cultural competency, and ethics to address interprofessional education core competencies. Course modifications and expanded student enrollment improved understanding of key health concepts and appreciation of interprofessional collaboration. (Am J Public Health. 2015;105:S106–S108. doi:10.2105/AJPH.2014.302502)
DURING THE PAST DECADE, interprofessional education (IPE) for the health professions has proliferated in educational settings across the United States. Early activities typically involved clinical disciplines such as medicine, pharmacy and nursing, partially in response to compelling calls for changes in the health care delivery system from the Institute of Medicine1 and World Health Organization.2 With the development of the Core Competencies for Interprofessional Collaborative Practice,3 inclusion of professions such as public health in IPE efforts has increased; currently, schools
S106 | Field Action Report | Peer Reviewed | Addy et al.
of public health are mandated to provide an interdisciplinary learning environment.4 Interprofessional collaborative practice is critically important to progress toward the triple aim of better care for individuals, better health for populations, and lower health care costs5 and meeting Healthy People 2020 objectives.6 This practice best occurs when health profession students develop core competencies through IPE experiences,3,7 including attention to the social determinants of health.8 Accordingly, central administration at the University of South Carolina (USC) created an interprofessional education committee. The committee, which quickly expanded from 5 members representing 5 schools and colleges in 2011 to more than 20 in 2014, was tasked to facilitate and deliver IPE learning and service opportunities to students from these colleges. One significant effort of this committee was the creation and implementation of a foundation IPE class, “Transforming Health Care for the Future.” This course initially paralleled a similar course developed at the Medical University of South Carolina9 and started in 2012 for 201 medical and pharmacy
students. In 2013, the class of 432 included nursing students. For the third delivery in 2014, the class included more than 500 students (Table 1), including all students in the physical therapy program and the Department of Communication Sciences and Disorders; public health and social work students—both graduate and undergraduate—could take the class as an elective. In this paper, we explore changes in the end-of-course evaluation based on course objectives and specific content areas after a substantial course revision, which was developed by a group of course coordinators to meet the needs of the expanded enrollment representing all USC health professions students. Because of varying curriculum and accreditation requirements of the separate programs, the course requirements were embedded into other larger courses for medicine and nursing but comprised stand-alone courses for pharmacy, public health, and social work. The overarching goals of the course were to address the competency domains articulated by the IPE Collaborative3: • values/ethics for interprofessional practice, • roles/responsibilities,
American Journal of Public Health | Supplement 1, 2015, Vol 105, No. S1
⏐ FIELD ACTION REPORT ⏐
TABLE 1—Interprofessional Class Participants Faculty/Student Facilitators
Students
School/College (Level)
2013, No.
2014, No.
2013, No.
2014, No.
Medicine (first year) Nursing (senior) Pharmacy (first year) Public Healtha (varied) Social Work (varied) Other Total
8 10 12 1 1 0 32
4 5 8 4 2 2 25
96 228 107 0 1 0 432
97 226 109 60 12 0 504
a
Includes physical therapy and communication sciences and disorders.
TABLE 2—Interprofessional Class Content Outline Session
Session Title
Session Content
Module 1
Introduction to the Course
Readiness for interprofessional learning survey Multimedia introduction to content Team introductions in Blackboard Videos and readings about patient safety and empathy
Module 2
Roles and Responsibilities of Health Professionals
Health professional scopes of practice and education requirements Roles of team members, patient safety, health care system
Module 3
Social Determinants of Health and Health Disparities
Readings and videos Student suggestions to improve health care in the state
Module 4
Negotiating Across Cultures; Values and Ethics
Readings and videos on the role of culture in health beliefs and practices Cross-cultural communication Cultural humility
Module 5
Healthcare System and Calls for Improvement
Escape Fire movie Readings
Module 6
Root Cause Analysis and Patient Safety
Institute for Healthcare Improvement Open School course Team root cause analysis on patient case: complex stroke patient in rural community with multiple barriers to care outcomes (access, health beliefs, health literacy, health-system dynamics, and so on) Student reflection on IPE experience
Note. IPE = interprofessional education.
• interprofessional communication, and • teams and teamwork. The course included 3 live meetings and a series of 6 web-based modules that students
completed either individually or with assigned small groups. All groups included representatives from as many of the various professions as possible. Each team had its own discussion board in the campus learning
Supplement 1, 2015, Vol 105, No. S1 | American Journal of Public Health
management system. In 2014, the live meetings were more interactive, with student-centered facilitation. Through experiential activities (readings, case discussions, interactive exercises, and
systems-based problem analysis) conducted in interprofessional teams, this course provided students with foundational knowledge on collaborative care, teamwork essentials, and enhanced communication in complex health systems. This interprofessional context allowed students to explore the art and science of teamwork and communication skills, ethical issues, health care disparities, and patient safety with expanded content in 2014 on cultural competency, social determinants of health, and psychosocial issues related to patient care (see Table 2 for course module descriptions). The course culminated with each small group working through a root cause analysis of a complex stroke patient case in 2014; this exercise was completed in the last live meeting, allowing for dynamic discussion of causes and solutions for the sentinel event. The curriculum was delivered and overseen by the IPE course directors; faculty and student facilitators reported that the revised structure was more organized, easier to deliver, and more enjoyable for participants. Students were asked to complete an online end-of-course evaluation with items designed to address course objectives and specific course content areas. Responses were on a scale of 1 (strongly disagree) to 5 (strongly agree). Student response rates were 59% and 79% for 2013 and 2014, respectively. The independent t-test of the course evaluation means shows that students’ rating of all course items significantly improved from 2013 to 2014 (Table 3). Encouragingly, the qualitative data related to the students’ reflections about the course supported
Addy et al. | Peer Reviewed | Field Action Report | S107
⏐ FIELD ACTION REPORT ⏐
TABLE 3—Course Evaluation Results From 2013 and 2014 Cohorts Question
Acknowledgments
2013 (n = 256), Mean (SD)
2014 (n = 394), Mean (SD)
t
We express sincere appreciation to the provost, the health science deans, other members of the IPE steering committee, and to the course facilitators for their support of the broader IPE initiative and this course in particular.
Through this course, my Appreciation of interprofessional collaboration increased Knowledge about specific professions increased Knowledge about my profession’s role in interprofessional work increased Teamwork skills improved
3.61 (1.07) 3.35 (1.17)
3.96 (1.00) 4.03 (0.95)
4.19** 7.76**
3.44 (1.11) 3.31 (1.08)
3.81 (1.08) 3.64 (1.05)
4.18** 3.92**
My knowledge in the following areas has improved because of course content Health Care System Cultural Competency Patient Safety/Error Reduction Ethics Social Determinants of Health Health Disparities
This article reports academic evaluation data but does not involve human subject research; therefore, no institutional review board approval with necessary.
3.63 (1.09) 3.41 (1.03) 3.68 (0.98) 3.47 (1.05) 3.57 (1.02) 3.51 (1.03)
3.88 (0.95) 3.89 (0.99) 4.00 (0.95) 3.77 (1.04) 3.88 (0.97) 3.84 (1.00)
2.99* 6.00** 4.13** 3.67* 3.87* 4.04**
References
This activity was worthwhile for my professional development
2.85 (1.26)
3.49 (1.23)
6.43**
I enjoyed learning with students from other professions as part of this activity
3.74 (1.07)
4.07 (0.94)
3.96**
Human Participant Protection
*P ≤ .01; **P ≤ .001.
the conclusion that the course objectives were being met. For example, students shared: • “It was really cool to be with all types of health care providers and work with them. It helped me understand them and be less intimidated to work with them.” • “We all have different ideas and ways of doing things, but when you talk about them and put them together, it becomes a better outcome for the patient.” • “A great idea to get students from different professional schools to work through patient cases together to see where each profession’s responsibilities lie and how to work together as a team to optimize patient care.” Providing an opportunity for students from clinical and population health programs to learn from and work with each other
improved understanding of public health and patient safety concepts and IPE competencies, as well as the importance of the social determinants of health and interprofessional collaboration. Going forward, the IPE committee at USC will continue to modify course content to improve the delivery of a curriculum to achieve IPE competencies. Additionally, planning is underway to deliver an advanced IPE experience (including IPE simulation class opportunities, IPE internships, and enhanced IPE service learning opportunities) to students in the health professions. Although current IPE efforts have leaned more toward clinical practice, future efforts will aim to include a greater focus on population health with inclusion of public health and social work students integral for success. This effort can serve as a model for other universities interested in
S108 | Field Action Report | Peer Reviewed | Addy et al.
incorporating public health and social work students and faculty in their IPE programming. ■
About the Authors Cheryl L. Addy is with the Arnold School of Public Health, University of South Carolina, Columbia. Teri Browne is with the College of Social Work, University of South Carolina, Columbia. Elizabeth W. Blake is with the South Carolina College of Pharmacy, Columbia. Jennifer Bailey is with the College of Education, University of South Carolina, Columbia. Correspondence should be sent to Cheryl Addy, PhD, Arnold School of Public Health, 921 Assembly Street, University of South Carolina, Columbia, SC 29208 (e-mail [email protected]). Reprints can be ordered at http://www. ajph.org by clicking on the “Reprints” link. This article was accepted on November 26, 2014.
Contributors All authors are members of the University of South Carolina Interprofessional Education for the Health Sciences Steering Committee. All authors contributed to the conceptualization, writing, and revision of the article.
1. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001. 2. World Health Organization. Framework for action on interprofessional education and collaborative practice. Available at: http://www.who.int/hrh/ resources/framework_action/en. Accessed on June 17, 2014. 3. Interprofessional Education Collaborative Expert Panel. Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. Washington, DC: Interprofessional Education Collaborative; 2011. 4. Council on Education for Public Health. Accreditation Criteria: Schools of Public Health. Silver Spring, MD: Council on Education for Public Health; 2011. 5. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood). 2008;27(3):759–769. 6. US Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2020. Available at: http://www.healthypeople.gov/2020/ default.aspx. Accessed on June 17, 2014. 7. Evans CH, Cashman SB, Page DA, Garr DR. Model approaches for advancing interprofessional prevention education. Am J Prev Med. 2011;40(2):245– 260. 8. Wartman SA. Commentary: academic health centers: the compelling need for recalibration. Acad Med. 2010;85(12):1821–1822. 9. Blue AV, Charles L, Howell D, et al. Introducing students to patient safety through an online interprofessional course. Adv Med Educ Pract. 2010;1:107–114.
American Journal of Public Health | Supplement 1, 2015, Vol 105, No. S1
Enhancing Interprofessional Education: Integrating Public Health and Social Work Perspectives | Cheryl L. Addy, PhD, Teri Browne, PhD, Elizabeth W. Blake, PharmD, Jennifer Bailey, MEd
National stakeholders in health system improvement and patient safety including accreditation bodies have requested health professional educational programs to include multiple interprofessional experiences through didactic and experiential opportunities. Clinical and population health faculty at the University of South Carolina redesigned and expanded an introductory interprofessional course to include more than 500 students from public health, social work, medicine, pharmacy, and nursing. Students participated in 3 live class meetings and completed required online coursework to explore concepts related to social determinants of health and health disparities, health system improvement, patient safety, cultural competency, and ethics to address interprofessional education core competencies. Course modifications and expanded student enrollment improved understanding of key health concepts and appreciation of interprofessional collaboration. (Am J Public Health. 2015;105:S106–S108. doi:10.2105/AJPH.2014.302502)
DURING THE PAST DECADE, interprofessional education (IPE) for the health professions has proliferated in educational settings across the United States. Early activities typically involved clinical disciplines such as medicine, pharmacy and nursing, partially in response to compelling calls for changes in the health care delivery system from the Institute of Medicine1 and World Health Organization.2 With the development of the Core Competencies for Interprofessional Collaborative Practice,3 inclusion of professions such as public health in IPE efforts has increased; currently, schools
S106 | Field Action Report | Peer Reviewed | Addy et al.
of public health are mandated to provide an interdisciplinary learning environment.4 Interprofessional collaborative practice is critically important to progress toward the triple aim of better care for individuals, better health for populations, and lower health care costs5 and meeting Healthy People 2020 objectives.6 This practice best occurs when health profession students develop core competencies through IPE experiences,3,7 including attention to the social determinants of health.8 Accordingly, central administration at the University of South Carolina (USC) created an interprofessional education committee. The committee, which quickly expanded from 5 members representing 5 schools and colleges in 2011 to more than 20 in 2014, was tasked to facilitate and deliver IPE learning and service opportunities to students from these colleges. One significant effort of this committee was the creation and implementation of a foundation IPE class, “Transforming Health Care for the Future.” This course initially paralleled a similar course developed at the Medical University of South Carolina9 and started in 2012 for 201 medical and pharmacy
students. In 2013, the class of 432 included nursing students. For the third delivery in 2014, the class included more than 500 students (Table 1), including all students in the physical therapy program and the Department of Communication Sciences and Disorders; public health and social work students—both graduate and undergraduate—could take the class as an elective. In this paper, we explore changes in the end-of-course evaluation based on course objectives and specific content areas after a substantial course revision, which was developed by a group of course coordinators to meet the needs of the expanded enrollment representing all USC health professions students. Because of varying curriculum and accreditation requirements of the separate programs, the course requirements were embedded into other larger courses for medicine and nursing but comprised stand-alone courses for pharmacy, public health, and social work. The overarching goals of the course were to address the competency domains articulated by the IPE Collaborative3: • values/ethics for interprofessional practice, • roles/responsibilities,
American Journal of Public Health | Supplement 1, 2015, Vol 105, No. S1
⏐ FIELD ACTION REPORT ⏐
TABLE 1—Interprofessional Class Participants Faculty/Student Facilitators
Students
School/College (Level)
2013, No.
2014, No.
2013, No.
2014, No.
Medicine (first year) Nursing (senior) Pharmacy (first year) Public Healtha (varied) Social Work (varied) Other Total
8 10 12 1 1 0 32
4 5 8 4 2 2 25
96 228 107 0 1 0 432
97 226 109 60 12 0 504
a
Includes physical therapy and communication sciences and disorders.
TABLE 2—Interprofessional Class Content Outline Session
Session Title
Session Content
Module 1
Introduction to the Course
Readiness for interprofessional learning survey Multimedia introduction to content Team introductions in Blackboard Videos and readings about patient safety and empathy
Module 2
Roles and Responsibilities of Health Professionals
Health professional scopes of practice and education requirements Roles of team members, patient safety, health care system
Module 3
Social Determinants of Health and Health Disparities
Readings and videos Student suggestions to improve health care in the state
Module 4
Negotiating Across Cultures; Values and Ethics
Readings and videos on the role of culture in health beliefs and practices Cross-cultural communication Cultural humility
Module 5
Healthcare System and Calls for Improvement
Escape Fire movie Readings
Module 6
Root Cause Analysis and Patient Safety
Institute for Healthcare Improvement Open School course Team root cause analysis on patient case: complex stroke patient in rural community with multiple barriers to care outcomes (access, health beliefs, health literacy, health-system dynamics, and so on) Student reflection on IPE experience
Note. IPE = interprofessional education.
• interprofessional communication, and • teams and teamwork. The course included 3 live meetings and a series of 6 web-based modules that students
completed either individually or with assigned small groups. All groups included representatives from as many of the various professions as possible. Each team had its own discussion board in the campus learning
Supplement 1, 2015, Vol 105, No. S1 | American Journal of Public Health
management system. In 2014, the live meetings were more interactive, with student-centered facilitation. Through experiential activities (readings, case discussions, interactive exercises, and
systems-based problem analysis) conducted in interprofessional teams, this course provided students with foundational knowledge on collaborative care, teamwork essentials, and enhanced communication in complex health systems. This interprofessional context allowed students to explore the art and science of teamwork and communication skills, ethical issues, health care disparities, and patient safety with expanded content in 2014 on cultural competency, social determinants of health, and psychosocial issues related to patient care (see Table 2 for course module descriptions). The course culminated with each small group working through a root cause analysis of a complex stroke patient case in 2014; this exercise was completed in the last live meeting, allowing for dynamic discussion of causes and solutions for the sentinel event. The curriculum was delivered and overseen by the IPE course directors; faculty and student facilitators reported that the revised structure was more organized, easier to deliver, and more enjoyable for participants. Students were asked to complete an online end-of-course evaluation with items designed to address course objectives and specific course content areas. Responses were on a scale of 1 (strongly disagree) to 5 (strongly agree). Student response rates were 59% and 79% for 2013 and 2014, respectively. The independent t-test of the course evaluation means shows that students’ rating of all course items significantly improved from 2013 to 2014 (Table 3). Encouragingly, the qualitative data related to the students’ reflections about the course supported
Addy et al. | Peer Reviewed | Field Action Report | S107
⏐ FIELD ACTION REPORT ⏐
TABLE 3—Course Evaluation Results From 2013 and 2014 Cohorts Question
Acknowledgments
2013 (n = 256), Mean (SD)
2014 (n = 394), Mean (SD)
t
We express sincere appreciation to the provost, the health science deans, other members of the IPE steering committee, and to the course facilitators for their support of the broader IPE initiative and this course in particular.
Through this course, my Appreciation of interprofessional collaboration increased Knowledge about specific professions increased Knowledge about my profession’s role in interprofessional work increased Teamwork skills improved
3.61 (1.07) 3.35 (1.17)
3.96 (1.00) 4.03 (0.95)
4.19** 7.76**
3.44 (1.11) 3.31 (1.08)
3.81 (1.08) 3.64 (1.05)
4.18** 3.92**
My knowledge in the following areas has improved because of course content Health Care System Cultural Competency Patient Safety/Error Reduction Ethics Social Determinants of Health Health Disparities
This article reports academic evaluation data but does not involve human subject research; therefore, no institutional review board approval with necessary.
3.63 (1.09) 3.41 (1.03) 3.68 (0.98) 3.47 (1.05) 3.57 (1.02) 3.51 (1.03)
3.88 (0.95) 3.89 (0.99) 4.00 (0.95) 3.77 (1.04) 3.88 (0.97) 3.84 (1.00)
2.99* 6.00** 4.13** 3.67* 3.87* 4.04**
References
This activity was worthwhile for my professional development
2.85 (1.26)
3.49 (1.23)
6.43**
I enjoyed learning with students from other professions as part of this activity
3.74 (1.07)
4.07 (0.94)
3.96**
Human Participant Protection
*P ≤ .01; **P ≤ .001.
the conclusion that the course objectives were being met. For example, students shared: • “It was really cool to be with all types of health care providers and work with them. It helped me understand them and be less intimidated to work with them.” • “We all have different ideas and ways of doing things, but when you talk about them and put them together, it becomes a better outcome for the patient.” • “A great idea to get students from different professional schools to work through patient cases together to see where each profession’s responsibilities lie and how to work together as a team to optimize patient care.” Providing an opportunity for students from clinical and population health programs to learn from and work with each other
improved understanding of public health and patient safety concepts and IPE competencies, as well as the importance of the social determinants of health and interprofessional collaboration. Going forward, the IPE committee at USC will continue to modify course content to improve the delivery of a curriculum to achieve IPE competencies. Additionally, planning is underway to deliver an advanced IPE experience (including IPE simulation class opportunities, IPE internships, and enhanced IPE service learning opportunities) to students in the health professions. Although current IPE efforts have leaned more toward clinical practice, future efforts will aim to include a greater focus on population health with inclusion of public health and social work students integral for success. This effort can serve as a model for other universities interested in
S108 | Field Action Report | Peer Reviewed | Addy et al.
incorporating public health and social work students and faculty in their IPE programming. ■
About the Authors Cheryl L. Addy is with the Arnold School of Public Health, University of South Carolina, Columbia. Teri Browne is with the College of Social Work, University of South Carolina, Columbia. Elizabeth W. Blake is with the South Carolina College of Pharmacy, Columbia. Jennifer Bailey is with the College of Education, University of South Carolina, Columbia. Correspondence should be sent to Cheryl Addy, PhD, Arnold School of Public Health, 921 Assembly Street, University of South Carolina, Columbia, SC 29208 (e-mail [email protected]). Reprints can be ordered at http://www. ajph.org by clicking on the “Reprints” link. This article was accepted on November 26, 2014.
Contributors All authors are members of the University of South Carolina Interprofessional Education for the Health Sciences Steering Committee. All authors contributed to the conceptualization, writing, and revision of the article.
1. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001. 2. World Health Organization. Framework for action on interprofessional education and collaborative practice. Available at: http://www.who.int/hrh/ resources/framework_action/en. Accessed on June 17, 2014. 3. Interprofessional Education Collaborative Expert Panel. Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. Washington, DC: Interprofessional Education Collaborative; 2011. 4. Council on Education for Public Health. Accreditation Criteria: Schools of Public Health. Silver Spring, MD: Council on Education for Public Health; 2011. 5. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood). 2008;27(3):759–769. 6. US Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2020. Available at: http://www.healthypeople.gov/2020/ default.aspx. Accessed on June 17, 2014. 7. Evans CH, Cashman SB, Page DA, Garr DR. Model approaches for advancing interprofessional prevention education. Am J Prev Med. 2011;40(2):245– 260. 8. Wartman SA. Commentary: academic health centers: the compelling need for recalibration. Acad Med. 2010;85(12):1821–1822. 9. Blue AV, Charles L, Howell D, et al. Introducing students to patient safety through an online interprofessional course. Adv Med Educ Pract. 2010;1:107–114.
American Journal of Public Health | Supplement 1, 2015, Vol 105, No. S1
