http://informahealthcare.com/jic ISSN: 1356-1820 (print), 1469-9567 (electronic) J Interprof Care, Early Online: 1–2 ! 2014 Informa UK Ltd. DOI: 10.3109/13561820.2014.962128

SHORT REPORT

Impact of a collaborative interprofessional learning experience upon medical and social work students in geriatric health care Paul Robert Gould1, Youjung Lee1, Shawn Berkowitz2 and Laura Bronstein1 Department of Social Work, Binghamton University, Binghamton, NY, USA and 2Department of Geriatrics, UHS, Johnson City, NY, USA

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Abstract

Keywords

Interprofessional collaborative practice is increasingly recognized as an essential model in health care. This study lends preliminary support to the notion that medical students (including residents) and social work students develop a broader understanding of one another’s roles and contributions to enhancing community-dwelling geriatric patients’ health, and develop a more thorough understanding of the inherent complexities and unique aspects of geriatric health care. Wilcoxon Signed Rank Tests of participants’ scores on the Index of Interdisciplinary Collaboration (IIC) indicated the training made significant changes to the students’ perception of interprofessional collaboration. Qualitative analysis of participants’ statements illustrated (1) benefits of the IPE experience, including complementary roles in holistic interventions; and (2) challenges to collaboration. The findings suggest that interprofessional educational experiences have a positive impact upon students’ learning and strategies for enhanced care of geriatric patients.

Collaboration, health and social care, interprofessional education, mixed methods, roles, team-based care

Introduction Interprofessional team-based practice is increasingly recognized as an essential model in health care (Reeves et al., 2010). Interprofessional education (IPE) constructs environments for students across various professions to identify and utilize the contributions of other disciplines in collaborative practice with patients, while maintaining and honing their discipline-specific skills and knowledge (Willison, 2008). Given that research shows prior positive interdisciplinary experiences portend future positive interdisciplinary collaboration (Bronstein, 2002), it is critical to facilitate changes in health care systems and to prepare students to function effectively in interprofessional care teams.

The IPE experience Graduate students from medicine and social work in upstate New York (USA) collaborated with a geriatrician and clinical social worker to conduct a comprehensive geriatric assessment (Ward, Reuben, Schmader, & Eamranond, 2011) in patients’ homes followed by a clinic-based consultation session. This assessment format incorporates a holistic view and response to the diverse yet interrelated needs of elders. The assessment was divided into five segments: (1) review of history of present illness, concerns, and related systems, (2) physical exam, (3) family interview, (4) professional consultation, and (5) reviewing findings and recommendations with patient and family. Faculty and students convened to review the assessment, share perspectives, and construct an intervention plan to address the complex Correspondence: Dr Paul Robert Gould, Department of Social Work, Binghamton University, P.O. Box 6000, Binghamton 13902-6000, NY, USA. E-mail: [email protected]

History Received 28 February 2014 Revised 30 June 2014 Accepted 2 September 2014 Published online 30 September 2014

physiological, psychological, and social factors impacting patients’ health.

Methods A mixed-method using a triangulation design-multilevel model with concurrent data collection and analyses (Creswell & Plano Clark, 2007) was employed to evaluate the IPE. Quantitative data were collected using a pre-post design to administer the Index of Interdisciplinary Collaboration (IIC) as adapted for healthcare settings with different professionals (Bronstein, 2002). Cronbach’s alphas for the IIC among participants at the pre and post tests were 0.85 and 0.87, respectively. Due to the limited sample size and non-normal distributions of IIC scores, the Wilcoxon signedrank test was used to test the significance within group differences before and after the training. For qualitative data collection, three focus groups and one interview were conducted over two years. Among those, two focus groups had six medical students, three social work students, and three medical residents participating together. One focus group had eight social work students only and one interview was conducted with a medical resident. Analysis of focus group data was conducted in three steps: (1) open coding, (2) axial coding, looking for connections among the concepts, and (3) selective coding, exploring cases displaying the identified themes (Strauss, 1987).

Results We define medical students as professional learners either in their fourth year of medical school or in residency. Social work students were in their final year of a Masters in Social Work (MSW) program. Nine medical students and 10 social work students participated in the study over two years.

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Table I. Pre- and post-test results on five subscales of the index of interdisciplinary collaboration (IIC): Mean (SD), Median (Mdn), and Wilcoxon Signed Ranks Test (N ¼ 18). Subscales Interdependence Newly created professional activities Flexibility

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Collective ownership of goals Reflection on process

Pre-test

Post-test

p

31.89 (3.08) Mdn ¼ 32.00 13.83 (2.50) Mdn ¼ 14.00 12.39 (1.46) Mdn ¼ 13.00 20.83 (4.09) Mdn ¼ 21.00 27.89 (5.47) Mdn ¼ 27.00

29.61 (3.94) Mdn ¼ 30.00 12.33 (3.41) Mdn ¼ 12.00 11.89 (2.19) Mdn ¼ 13.00 18.83 (4.34) Mdn ¼ 17.50 25.44 (5.95) Mdn ¼ 25.50

0.092 0.056 0.430 0.213 0.029

Quantitative findings Wilcoxon Signed Rank Tests indicated the IPE made significant changes to participants’ perception of interprofessional collaboration (Z ¼ 2.202, p ¼ 0.028) in these other settings (Table I). One sample was dropped from the analysis due to missing items in the post-test. The median scores on the IIC before and after the training were 105.5 and 97.5, respectively, showing that participants’ level of interprofessional collaboration increased after the IPE. Also, as illustrated in Table I, significant increases in the IIC subscale reflection on process was observed (Z ¼ 2.190, p ¼ 0.029) indicating participants had increased attention to their process of working together. Qualitative findings Two major themes relating to the IPE and implications for interprofessional practice emerged during qualitative data analysis: (1) benefits of collaborative experiential learning environment, including complementary roles in holistic interventions, and (2) challenges to interprofessional collaboration. Medical students recognized their training was primarily facilitated by physicians, and while they routinely interacted with nurses, these interactions were not collaborative in nature. Students demonstrated a greater appreciation for each disciplines’ contributions in a holistic approach to geriatric patient care. Participants recognized value in the collaborative processes of assessment and constructing an intervention plan, noting the final recommendations to the family encompassed a broader range of contributing factors, thus providing a more holistic strategy. While participants identified effective communication between disciplines as a primary asset to patients’ health care, they acknowledged significant barriers related to collaborative practice. Medical students noted how scheduling of patients limited their ability to conduct an in-depth assessment and have collateral contacts with team members. This is further complicated by a lack of a common style of presenting information among disciplines. These barriers often undermine the ability to reap the benefits of an interprofessional approach in geriatric health care, and hinder both disciplines’ ability to address the interrelated physiologicalpsychosocial factors compromising patients’ functioning.

Discussion This IPE experience illustrates the opportunities inherent in collaborative education and practice between physicians and social workers to provide enhanced health care to older adults. Students recognized the value of the opportunity to learn from one another. The collaborative approach provided a more thorough understanding of patients’ needs and abilities, as well as a broader range of pharmacological and non-pharmacological interventions to address complex health conditions in geriatric patients. Most students noted this was their only interprofessional experience with the other discipline, although all students were about to graduate. Time and communication remain considerable barriers to effective collaborative practice. An emerging resolution to these challenges is utilization of a team-based care approach. Using an on-site team approach allows interprofessional dialogue during regularly scheduled meetings. By having social workers on-site as part of the health care team, time may be dedicated for communication regarding complex patients. Overall, participants from both disciplines noted the IPE was a rare experience in their education, and believed greater emphasis should be placed upon these types of experiences in professional health care education

Conclusion This study illustrates the benefits to medical and social work students through participation in an IPE experience, their insights regarding benefits of collaborative care to geriatric patients, as well as challenges to sustaining an interprofessional model in practice. Students from both disciplines reported enhanced awareness of processes involved in interprofessional collaboration. Similar educational experiences may provide opportunities for health care disciplines to develop a foundation for collaborative practice.

Declaration of interest No conflict of interest exists among the authors. No pharmaceutical companies provided funding.

References Bronstein, L.R. (2002). Index of interdisciplinary collaboration. Social Work Research, 26, 113–125. Creswell, J.W., & Plano Clark, V.L. (2007). Designing and conducting mixed methods research. Thousand Oaks, CA: Sage. Reeves, S., Zwarenstein, M., Goldman, J., Barr, H., Freeth, D., Koppel, I., & Hammick, M. (2010). The effectiveness of interprofessional education: Key findings from a new systematic review. Journal of Interprofessional Care, 24, 230–241. Strauss, A. (1987). Qualitative analysis for social scientists. New York, NY: Cambridge University Press. Ward, K.T., Reuben, D.B., Schmader, K.E., Eamranond, P. (2011). Comprehensive geriatric assessment. Retrieved from www.uptodate. com Willison, K.D. (2008). Advancing integrative medicine through interprofessional education. Health Sociology Review, 17, 342–352.

Impact of a collaborative interprofessional learning experience upon medical and social work students in geriatric health care.

Interprofessional collaborative practice is increasingly recognized as an essential model in health care. This study lends preliminary support to the ...
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