Interprofessional Education: An Innovative Approach to Increase the Human Immunodeficiency Virus Workforce.

Ending the human immunodeficiency virus (HIV) epidemic relies on a robust clinical workforce. The Southeast AIDS Education and Training Center's interprofessional education program is a novel approach to increasing the interest and ability of early health professional learners to provide high-quality, comprehensive, person-first care for people with HIV. Key Points: Interprofessional education (IPE) focusing on multidisciplinary care for people with HIV can serve as a novel way to increase the HIV workforce. This brief report describes the IPE program of the Southeast AIDS Education and Training Center.

Dental student perceptions of teamwork during a community-engaged interprofessional learning experience.

INTRODUCTION: Dental professionals have been strong advocates for interprofessional education (IPE). During PFF, students in diverse, interprofessional teams of four are assigned a local volunteer family during their first academic year. Teams conduct four home visits and implement a health improvement project focused on the family's health and well-being. The purpose of our analysis was to examine dental student perspectives on the use of teamwork skills during this unique interprofessional educational experience. METHODS AND MATERIALS: Dental student responses from 2017 to 2018 and 2018 to2019 were qualitatively analysed. Open coding by hand was used to identify keywords and themes. The themes and open codes were compared and contrasted by the researchers until a consensus was reached on themes. RESULTS: Researchers discerned three meta-themes: value, skills and time. Researchers also found eight sub-themes prevalent in responses: teamwork, adaptability, mutual support, trust, interprofessional communication, time, feedback, coordination and accountability. DISCUSSION: Our findings indicate dental students understood the importance of interprofessional teamwork and experiential learning within the context of PFF. Students communicated an understanding of how teamwork skills can impact team-oriented outcomes. Dental students seemed to value many teamwork skills that contributed to their interprofessional team's success and experiential learning experience. CONCLUSION: Engagement in a longitudinal experience that is patient-centred, requiring time outside of the classroom, is valued by dental students for its interprofessional collaborative competency development.

Design of a Situational Judgment Test for Preclinical Interprofessional Collaboration.

PROBLEM: There is an unmet need for economically feasible, valid, reliable, and contextually relevant assessments of interprofessional collaborative knowledge and skills, particularly at the early stages of health professions education. This study sought to develop and gather content and internal structure validity for an Interprofessional Situational Judgement Test (IPSJT), a tool for the measurement of students' interprofessional collaborative intentions during the early stages of their professional development. APPROACH: After engaging in an item development and refinement process (January-June 2018), an 18-question IPSJT was administered to 953 first-year students enrolled in 10 health professions degree programs at the University of Florida Health Science Center in October 2018. The IPSJT's performance was evaluated using item-level analyses, item difficulty, test-retest reliability, and exploratory factor analysis. OUTCOMES: Seven hundred thirty-seven (77.3%) students consented to the use of their data. Student IPSJT scores ranged from 0 to 69, averaging 42.68 (standard deviation = 12.28), with some statistically significant differences in student performance by health professions degree program. IPSJT item difficulties ranged from 0.13 to 0.92. Once one item with poor properties was excluded from analysis, the IPSJT demonstrated an overall reliability of 0.62. Students were more successful at identifying the least effective than the most effective responses. Test-retest reliability provided evidence of consistency (r = 0.50, P < .001) and similar item difficulty across administrations. An exploratory factor analysis indicated a 3-factor model with multiple cross-factor loadings. NEXT STEPS: This work represents the first step toward the development of a valid, reliable IPSJT for early learners. The emergent 3-factor model provides evidence that multiple competencies can be assessed in early learners via this tool. Additional research is necessary to build a more robust question bank, explore different scoring and response methods, and gather additional sources of validity evidence, including relations to other variables.

Physician Cultural Competency Training and Impact on Behavior: Evidence From the 2016 National Ambulatory Medical Care Survey.

BACKGROUND AND OBJECTIVES: The number of racially and culturally diverse patients in the medical practices of US physicians is increasing. It is unclear how well culturally and linguistically appropriate services (CLAS) standards have been integrated into physician practice. The objective of this study was to determine the prevalence of US-based physicians who received training in cultural competency and describe their behavior. METHODS: This survey study utilized data from a supplement of the 2016 National Ambulatory Medical Care Survey (NAMCS). The NAMCS Supplement on CLAS for Office-based Physicians (National CLAS Physician Survey) is a nationally representative survey of ambulatory physicians. We determined the proportion and characteristics of physicians who reported receiving cultural competency training in medical school or in practice. RESULTS: The unweighted sample of 363 yielded a weighted sample of 290,109 physicians, 66.3% of whom reported that they had received cultural competence training at some point. Only 35.5% of the sample had ever heard of the CLAS standards, suggesting a low level of awareness of the standards. Further, only 18.7% reported that training in cultural competency is required for newly hired physicians who join their practice. There were no statistically significant differences between those who had been trained and those who had not in terms of self-reported consideration of race/ethnicity or culture in assessing patient needs, diagnosis, treatment and patient education (P>.05). CONCLUSIONS: Fewer than half of practicing physicians reported receiving cultural and linguistic competency training in medical school or residency. It is possible that cultural competence training is being seamlessly integrated into medical education.

The level of evidence of medical marijuana use for treating disabilities: a scoping review.

Purpose: Twenty-nine states have bypassed federal regulations by legalizing marijuana (MJ) either medicinally, recreationally or both. The FDA states that there is no empirical evidence that MJ is effective to treat these disorders. With over a billion individuals living with a disability across the globe, it is crucial to fully research the efficaciousness and safety of medical MJ to treat this population. The purpose to present the results of a scoping review of studies focused on the levels of evidence currently available on medical MJ's efficacy in treatment across a large range of disabilities.Methods: Databases were searched for research articles on the current level of evidence to support medical MJ use among people with disabilities.Results: Forty-one peer reviewed articles met the inclusion criteria. Articles focused on attention deficit hyperactivity disorder, post-traumatic stress disorder, depression, schizophrenia, spinal cord injury, multiple sclerosis/movement disorders, fibromyalgia, epilepsy, with some that focused on multiple disabilities.Conclusions: The level of evidence for the use of medical MJ among people with disabilities varies greatly, and has a clear lack of methodologically sound studies. Overall, medical MJ does not improve the level of functioning, but it may improve the overall quality of life for people with disabilities.Implications for RehabilitationEpilepsy can be a disabling chronic disorder which not only impacts physically but can restricts quality of life.Quality of life is diminished even more with treatment resistant epilepsy.Chronic pain is the leading cause of disability and is the most common cause of long-term disability.There is sufficient evidence that medical marijuana is effective in treating epileptic seizures and chronic pain.Medical marijuana may improve the level of functioning and quality of life for individuals with certain disabilities.

Assessment and evaluation in interprofessional education: exploring the field.

BACKGROUND: The practice of interprofessional education (IPE) is expanding rapidly in the United States and globally. The publication of competencies from the Interprofessional Education Collaborative (IPEC) was a significant step forward to recognize the importance of health professions collaboration and to guide institutions for educational program development. However, there remains substantial difficulty in implementation, as well as considerable variability in assessment of learners' interprofessional collaborative knowledge and skills and evaluation of IPE programs. METHODS: We conducted a multi-methods project which included 20 key informant interviews, a literature review, and a meeting of an expert panel. Our goals were 1) explore the current field of IPE, 2) identify and disseminate best practices to institutions wishing to implement/augment IPE assessment and evaluation processes, 3) uncover gaps in current IPE assessment and evaluation practices, and 4) recommend next steps for the field. RESULTS: A small and growing literature indicates evidence of the effectiveness of IPE. A diverse collection of methods and tools are used to assess and evaluate IPE learners and programs; these are often used without an explicit program-evaluation framework. CONCLUSIONS: For the field to advance and to align with the demands of changing clinical care systems, robust assessment and evaluation methods, standardized use of common tools, and longitudinal assessment from diverse data streams are needed for IPE.

Junior Doctors of Health©: an interprofessional service-learning project addressing childhood obesity and encouraging health care career choices.

While much literature describes programmatic success of clinical service-learning opportunities, this initiative integrates student learning across a comprehensive discipline set (Dental Medicine, Graduate Studies, Health Administration, Medicine, Nursing, Occupational Therapy, Pharmacy, Physical Therapy, and Physician Assistant), providing preventive health education and role modeling to low-income elementary-school children. Junior Doctors of Health© (JDOH), a health education curriculum taught by Medical University of South Carolina students, addresses childhood obesity and encourages child interest in health professional (HP) and biomedical science (BS) careers. Of the 78 surveyed HP/BS students, over 80% agreed JDOH was worthwhile for their professional development, increased their appreciation and ability as an interprofessional team member, improved their understanding and interest in underserved communities, and provided them with valuable childhood-obesity prevention information. With the increased need for childhood-obesity prevention and team building among students of various health and science professions, recommendations are offered to others interested in creating or collaborating to build similar service-learning initiatives.

Creating Collaborative Care (C3), Medical University of South Carolina.

The Creating Collaborative Care (C3) program is a university-wide, comprehensive interprofessional education initiative. It was developed as the university's Quality Enhancement Plan for reaffirmation of accreditation by the Southern Association of Colleges and Schools. Four student learning goals guide the initiative and development of its components. C3 activities include required academic (including health care simulation experiences), co-curricular, and faculty development. C3 was established in 2007, though some activities pre-date its establishment. Funding is primarily from the university, though small grants have supported development of a few activities. Since aspects of the program are required, students receive academic credit for participation; for co-curricular activities, they do not. The C3 program extends over the course of a student's education at MUSC.

Changing the future of health professions: embedding interprofessional education within an academic health center.

Institutions are increasingly considering interprofessional education (IPE) as a means to improve health care and reduce medical errors in the United States. Effective implementation of IPE within health professions education requires a strategic institutional approach to ensure longevity and sustainability. In 2007, the Medical University of South Carolina (MUSC) established Creating Collaborative Care (C), an IPE initiative that takes a multifaceted approach to weaving interprofessional collaborative experiences throughout MUSC's culture to prepare students to participate in interprofessional, collaborative health care and research settings.In this article, the authors describe C's guiding conceptual foundation and student learning goals. They present its implementation framework to illustrate how C is embedded within the institutional culture. It is housed in the provost's office, and an overarching implementation committee functions as a central coordinating group. Faculty members develop and implement C activities across professions by contributing to four collaborating domains-curricular, extracurricular, faculty development, and health care simulation-each of which captures an IPE component. The authors provide examples of IPE activities developed by each domain to illustrate the breadth of IPE at MUSC. The authors believe that MUSC's efforts, including the conceptual foundation and implementation framework, can be generalized to other institutions intent on developing IPE within their organizational cultures.

Promoting students' community service during medical school: the MUSC Gives Back Office.

BACKGROUND: Health professions education recognizes the value of students' engagement in community service, exemplified by the Liaison Committee on Medical Education's adoption in 2007 of a standard requiring service learning opportunities to be available for medical students. DESCRIPTION: At our institution, a community service office was established in 1993 to provide students information about volunteer community service opportunities. EVALUATION: Since 1993, more than 150,000 service hours have been performed by students in the community. There has been a clear increase in medical student participation. We have found that medical school community service participation is positively associated with better academic performance and can influence residency selection and participation in service following graduation. CONCLUSIONS: With the increased need to develop service opportunities for students, institutions will be required to establish infrastructures to support this. We offer recommendations to others interested in a creating a similar office or program for students.

Introducing students to patient safety through an online interprofessional course.

Interprofessional education (IPE) is increasingly called upon to improve health care systems and patient safety. Our institution is engaged in a campus-wide IPE initiative. As a component of this initiative, a required online interprofessional patient-safety-focused course for a large group (300) of first-year medical, dental, and nursing students was developed and implemented. We describe our efforts with developing the course, including the use of constructivist and adult learning theories and IPE competencies to structure students' learning in a meaningful fashion. The course was conducted online to address obstacles of academic calendars and provide flexibility for faculty participation. Students worked in small groups online with a faculty facilitator. Thematic modules were created with associated objectives, online learning materials, and assignments. Students posted completed assignments online and responded to group members' assignments for purposes of group discussion. Students worked in interprofessional groups on a project requiring them to complete a root cause analysis and develop recommendations based on a fictional sentinel event case. Through project work, students applied concepts learned in the course related to improving patient safety and demonstrated interprofessional collaboration skills. Projects were presented during a final in-class session. Student course evaluation results suggest that learning objectives and content goals were achieved. Faculty course evaluation results indicate that the course was perceived to be a worthwhile learning experience for students. We offer the following recommendations to others interested in developing an in-depth interprofessional learning experience for a large group of learners: 1) consider a hybrid format (inclusion of some face-to-face sessions), 2) address IPE and broader curricular needs, 3) create interactive opportunities for shared learning and working together, 4) provide support to faculty facilitators, and 5) recognize your learners' educational level. The course has expanded to include students from additional programs for the current academic year.

Assessment of matriculating medical students' knowledge and attitudes towards professionalism.

BACKGROUND: Students' perceptions of traditional attributes of professionalism are important for understanding their professional development needs, and determining appropriate curricular initiatives and assessment methods. AIM: This study assessed the knowledge and attitudes towards professionalism of three classes of matriculating students at two institutions. METHODS: Subjects completed four instruments: a multiple-choice test and a clinical scenario instrument assessed knowledge; and a semantic differential scale and Likert-format statement instrument assessed attitudes. Items reflected traditional professionalism attributes. Factor analysis identified scales and descriptive statistics were computed for each scale. RESULTS: Six hundred and forty six students (82%) completed the instruments. Correlations among scales were low to moderate. Knowledge scores were highest for the attributes 'humanism' and 'professional responsibility' and lowest for the attribute 'professional commitment'. Attitude scores were highest for 'humanistic values' and lowest for 'subordinating self-interests'. CONCLUSIONS: Results indicate students' attitudes are positive about several of the attributes associated with traditional professionalism definitions; however, there were cases where students' knowledge and attitudes towards professionalism appear incongruent with traditional definitions. Further development of self-assessments of knowledge and attitudes towards professionalism are suggested.

Impact of the foundations of clinical medicine course on USMLE scores.

BACKGROUND: The synthesis of basic and clinical science knowledge during the clerkship years has failed to meet educational expectations. OBJECTIVES: We hypothesized that a small-group course emphasizing the basic science underpinnings of disease, Foundations of Clinical Medicine (FCM), could be integrated into third year clerkships and would not negatively impact the United States Medical Licensure Examination (USMLE) step 2 scores. DESIGN: In 2001-2002, all third year students met weekly in groups of 8-12 clustered within clerkships to discuss the clinical and basic science aspects of prescribed, discipline-specific cases. PARTICIPANTS: Students completing USMLE step 2 between 1999 and 2004 (n = 743). MEASUREMENTS: Course evaluations were compared with the overall institutional average. Bivariate analyses compared the mean USMLE steps 1 and 2 scores across pre- and post-FCM student cohorts. We used multiple linear regression to assess the association between USMLE step 2 scores and FCM cohort controlling for potential confounders. RESULTS: Students' average course evaluation score rose from 66 to 77 (2001-2004) compared to an institutional average of 73. The unadjusted mean USMLE step 1 score was higher for the post-FCM cohort (212.9 vs 207.5, respectively, p < .001) and associated with step 2 scores (estimated coefficient = 0.70, p < .001). Post-FCM cohort (2002-2004; n = 361) mean step 2 scores topped pre-FCM (1999-2001; n = 382) scores (215.9 vs 207.7, respectively, p < .001). FCM cohort remained a significant predictor of higher step 2 scores after adjustment for USMLE step 1 and demographic characteristics (estimated coefficient = 4.3, p = .002). CONCLUSIONS: A curriculum integrating clinical and basic sciences during third year clerkships is feasible and associated with improvement in standardized testing.

Medical school application interview score has limited predictive validity for performance on a fourth year clinical practice examination.

BACKGROUND AND PURPOSE: : Data supporting the predictive validity of the medical school admission interview are mixed. This study tested the hypothesis that the admission interview is predictive of interpersonal interactions between medical students and standardized patients. METHOD: : We determined correlations between admission interview scores and performance on a senior-year Clinical Practice Examination piloting US National Board of Medical Examiners stations. We also completed regression analyses controlling for undergraduate academic performance, gender and ethnicity. Outcome measures included an Interpersonal Skills score and a separate Overall Checklist performance score, completed by standardized patients. RESULTS: : The applicant interview had limited but statistically significant correlation with the Interpersonal Skills (r = 0.15; p < 0.05) score. The applicant interview had a correlation of 0.13 with the Overall Checklist score (p = .056). In linear regression models, the applicant interview had limited but statistically significant correlations with the Interpersonal Skills score and the Overall Checklist score. CONCLUSION: : As practiced at this medical school, the admission interview has limited predictive validity for future interactions with standardized patients. More comprehensive assessment of interpersonal skills during the medical school selection process will be needed in order to better select matriculants with desirable interpersonal skills.

Performance outcomes associated with medical school community service.

BACKGROUND: Providing medical students with community service opportunities during medical school is believed to foster altruism. Little is known whether voluntary community service is associated with students' academic and clinical skill performance. This study examined the relationship between students' volunteer community service hours during medical school and their medical school academic performance, measures of clinical skills, and residency performance. METHOD: Subjects were 2001 and 2002 graduates of the institution. Performance measures were: United States Medical Licensing Examination (USMLE) Step 2 score, grade point average, fourth-year clinical skills examination scores, and two types of residency director assessments. Associations between performance measures and community service hour categories were analyzed using descriptive statistics, chi-square, and t-tests. RESULTS: Students in the highest service group (>/=18.5 hours) had significantly higher grade point averages, USMLE Step 2 scores, and scores on both residency director assessment when compared to students with no community service hours. CONCLUSIONS: Community service involvement in medical school appears associated with medical school academic and residency performances.

How well are practice management curricula preparing family medicine residents?

BACKGROUND: While emphasis has been placed on practice management curricula in residency, studies indicate that residents are not adequately prepared. To assess the effectiveness of current practice management skills training in residency, we examined the confidence levels of family medicine residents and recent graduates in practice management skills. METHODS: A survey was sent to family medicine residency programs within South Carolina. Participants ranked their confidence level in 13 practice management skills on a 5-point Likert scale. Analysis of covariance compared confidence levels in their skills while controlling for program, gender, and age. Residency directors of these programs were also surveyed about the content of their practice management programs. RESULTS: Residents and graduates rated their confidence in all areas moderately high. Graduates rated themselves significantly more confident than residents did in seven practice management skills. CONCLUSIONS: Family medicine practice management curricula appear to be effective in establishing confidence regarding practice management skills in residents and recent graduates.