Early outcomes from a national Train-the-Trainer Interprofessional Team Development Program.

The imperative need to train health professions faculty (educators and clinicians) to lead interprofessional education efforts and promote interprofessional team-based care is widely recognized. This need stems from a growing body of research that suggests collaboration improves patient safety and health outcomes. This short report provides an overview of a Train-the-Trainer Interprofessional Team Development Program (T3 Program) that equips faculty leaders with the skills to lead interprofessional education and interprofessional collaborative practice across the learning continuum. We also describe the history, approach, and early outcomes of this innovative program.

Measuring the Impact of the National Train-the-Trainer Interprofessional Team Development Program (T3-ITDP) on the Implementation of Interprofessional Education and Interprofessional Collaborative Practice.

BACKGROUND: In order to prepare current and future educators and clinicians to lead interprofessional education (IPE) and interprofessional collaborative practice (IPCP), faculty and staff need training in collaborative approaches to developing, implementing, assessing, and sustaining high quality IPE across the interprofessional learning continuum. The Train-the-Trainer Interprofessional Team Development Program (T3-ITDP) is a 3.5-day program designed to develop expert IPE teams through interactive workshops, coaching, and the development and implementation of an IPE or IPCP (IPECP) project for their home institutions. PURPOSE: The purpose of this research was to assess the impact of the T3-ITDP on the development and implementation of IPECP projects by participating teams. METHODS: The T3-ITDP impact survey was created and administered to collect data on the scope and impact of participant teams' projects, including learner and project outcomes, training methods, dissemination plans, assessment strategies, and teams' intentions to continue working together beyond the initial project. With human subject's approval, we invited 55 T3-ITDP participant teams to complete the impact survey. These teams were at least one year post-completion of the in-person portion of the program and thus had time to initiate their IPECP projects. RESULTS: Forty-one (74.5%) teams responded to the survey. Of those teams, 31 (76%) used T3-ITDP content and/or approaches to develop their IPECP projects that targeted learners across the interprofessional learning continuum. Sustainability of IPECP projects was supported through several mechanisms, including institutional support or incorporating IPECP activities into existing courses. Almost half of the teams worked together on new projects, and 74% of teams planned to repeat a newly developed activity. DISCUSSION & CONCLUSIONS: Results of the T3-ITDP impact survey demonstrated that team-based, project-focused professional development catalyzed the development, implementation, and sustainment of new IPECP projects at academic and community institutions throughout the U.S.

Mattering: How Organizations, Patients, and Peers Can Affect Nurse Burnout and Engagement.

OBJECTIVE: The aim of this study was to explore professional mattering in a broad cohort of nurses. BACKGROUND: Mattering is a construct from social psychology that describes the feeling that one makes a difference in the lives of others and has significance in one's community. METHODS: A cross-sectional survey assessing mattering, meaning, social support, burnout, and engagement was administered to nurses and nurse practitioners working in various specialties in the United States. RESULTS: Higher levels of mattering at work were associated with lower burnout and higher engagement. Mattering was correlated with perceived social support from one's organization, supervisor, peers, and subordinates. Open-ended responses describing experiences of mattering at work included demonstrating professional competence, positive interactions with patients and interprofessional peers, and receiving recognition from one's organization. CONCLUSIONS: A perception of mattering at work is associated with lower levels of burnout. Our data suggest that affirming interactions with other healthcare team members promote a sense of mattering.

The ASPIRE Model: Grounding the IPEC core competencies for interprofessional collaborative practice within a foundational framework.

Interprofessional education (IPE) and interprofessional collaborative practice (ICP) are essential to achieving high-quality patient care. Leading IPE/ICP requires training in new knowledge and skills that most health professions faculty and clinicians lack. To guide this training, the Interprofessional Education Collaborative (IPEC) defined interprofessional collaboration through four core competencies: (a) Values/Ethics for Interprofessional Practice, (b) Roles/Responsibilities, (c) Interprofessional Communication, and (d) Teams and Teamwork. For IPE/ICP training to be effective, it is necessary to identify new educational models that provide an operational framework for these competencies. The University of Virginia (UVA) ASPIRE Model is a new paradigm for developing IPE/ICP educational experiences. It was created by mapping the IPEC competencies to three overlapping curricular content areas: (a) Practical Tools, (b) Leadership, and (c) Relational Factors. This model shows the relationship among the four IPEC core competencies and corresponding sub-competency statements and their inclusion in one or more of these three curricular content areas. The UVA ASPIRE Model was empirically tested as an approach to provide IPE/ICP training through "real-world" application for clinicians and faculty participating in an intensive team development program. Positive evaluations and improved capabilities of learners to apply their new knowledge and skills to solving real-world clinical challenges revealed that the UVA ASPIRE Model is an effective approach to embed the IPEC competencies in the design of IPE/ICP educational activities.

Perceptions of Teamwork in the Interprofessional Bedside Rounding Process.

Patient perceptions of teamwork have been a relatively undiscovered domain. Our study investigated the use of the Patients' Insights and Views of Teamwork (PIVOT) survey on an acute cardiology unit in an academic teaching hospital with patients receiving Rounding with Heart, an interprofessional bedside rounding initiative, and others receiving traditional rounding processes. Sixty-three subjects were surveyed during their hospital stay. We found a significant difference (p = .006) in PIVOT scores between those receiving interprofessional rounding and those not receiving this rounding structure. In an item-by-item analysis, four specific items were found to be significant which were supported by analysis of qualitative data. Observations of the structured interprofessional rounding process by our research team reveal themes that emerged from observations: (1) openness/inclusivity, (2) patient-centeredness, (3) attending role/shared leadership, (4) nonconfrontational learning, (5) efficacy, and (6) team at bedside. Our results indicate that patients may be able to recognize the teamwork in the structured bedside rounding process and that interfacing with the team may be an important component to patients. We conclude that patient perceptions of teamwork are a valuable informant to modeling collaborative practices, and there are key observable components to the structured rounding model that may foster collaboration among different disciplines.

Effectiveness of an interprofessional workshop on pain management for medical and nursing students.

Interprofessional (IP) care is critical for effective pain management, but evidence is lacking about the best way to teach pain management skills to medical and nursing students using IP strategies. In 2013 and 2014, 307 medical and 169 nursing students participated in an IP case-based pain management workshop. The aims of this study were to determine (1) if students who participate in IP case-based learning groups will have improved pain management skills compared to students who participate in uniprofessional case-based learning groups, and (2) if students mentored by faculty with IP training will have improved pain management skills compared to students who are not mentored by IP-trained faculty. Student learning was assessed and compared using scored checklists for each group's pain management plans. Findings show that IP mentorship and IP group participation improved medical students' pain management skills but did not have the same effect on nursing student performance. Continued work is needed to develop, refine, and integrate innovative and tailored IP strategies into the curricula of medical and nursing schools to advance the pain management competencies of students before they enter clinical practice.

Measuring the impact of clinically relevant interprofessional education on undergraduate medical and nursing student competencies: A longitudinal mixed methods approach.

Interprofessional education (IPE) to improve collaborative competencies is essential for delivering high-quality care. Yet creating clinically relevant IPE and linking it to improvements in behaviours remains challenging, and few objective measurement instruments are available. We developed a process for creating IPE and objective observational tools through collaborative care best practice models (CCBPMs). These models describe the professional and interprofessional behaviours needed for specific patient populations, illnesses, and care settings. Four IPE workshops based on CCBPMs were implemented for all medical and nursing students during their clinical/clerkships years. Students in Cohort 1 completed two IPE workshops: rapid response and end-of-life. For Cohort 2, students completed four IPE workshops, adding chronic paediatric illness and transitions for the cognitively impaired. Valid and reliable collaborative behaviors observational assessment tools (CBOATs) derived from CCBPMs for the rapid response and end-of-life workshops were developed. CBOATs were used in the longitudinal assessment of student learning for both cohorts during two Interprofessional Teamwork Objective Structured Clinical Examinations (ITOSCEs) conducted before and after the students completed the IPE workshops. Over a 2-year period, 457 students completed the IPE simulations and ITOSCEs. Both medical and nursing students demonstrated significant improvement in CBOAT scores. Comparisons between the cohorts showed that participation in four versus two IPE experiences did not significantly improve most CBOAT scores. We conclude that undergraduate IPE simulation experiences based on CCBPMs result in measurable improvements in learner behaviours necessary for effective collaborative and team-based practice in specific care areas.

Interprofessional training enhances collaboration between nursing and medical students: A pilot study.

BACKGROUND: Effective collaboration among healthcare providers is an essential component of high-quality patient care. Interprofessional education is foundational to ensuring that students are prepared to engage in optimal collaboration once they enter clinical practice particularly in the care of complex geriatric patients undergoing surgery. STUDY DESIGN: To enhance interprofessional education between nursing students and medical students in a clinical environment, we modeled the desired behavior and skills needed for interprofessional preoperative geriatric assessment for students, then provided an opportunity for students to practice skills in nurse/physician pairs on standardized patients. This experience culminated with students performing skills independently in a clinic setting. RESULTS: Nine nursing students and six medical students completed the pilot project. At baseline and after the final clinic visit we administered a ten question geriatric assessment test. Post-test scores (M=90.33, SD=11.09) were significantly higher than pre-test scores (M=72.33, SD=12.66, t(14)=-4.50, p<0.001. Nursing student post-test scores improved a mean of 22.0 points and medical students a mean of 11.7 points over pre-test scores. Analysis of observational notes provided evidence of interprofessional education skills in the themes of shared problem solving, conflict resolution, recognition of patient needs, shared decision making, knowledge and development of one's professional role, communication, transfer of interprofessional learning, and identification of learning needs. CONCLUSIONS: Having nursing and medical students "learn about, from and with each other" while conducting a preoperative geriatric assessment offered a unique collaborative educational experience for students that better prepares them to integrate into interdisciplinary clinic teams.

A novel interprofessional approach to end-of-life care education: A pilot study.

Navigating the biomedical, emotional, and logistical complexity of end-of-life (EOL) care requires seamless interprofessional teamwork. Unfortunately, EOL care, interprofessional collaboration, and the role of support services such as hospice are not adequately emphasized in nursing and medical curricula. This article describes a student-run program, entitled the "HeArt of Medicine", which was designed to foster a reflective and collaborative approach to EOL care. The program consists of three workshops with a novel blend of art, science, and practical information, highlighting the need for interprofessional teamwork. Participants were surveyed before and after the workshops on their attitudes toward EOL care. Composite participant scores after workshops demonstrated increased comfort with and knowledge of EOL care topics (p = 0.001). The results show that this program has had a positive impact on participants' knowledge, comfort, and collaboration in EOL settings.

Interprofessional education and practice guide no. 2: developing and implementing a center for interprofessional education.

The complexity of implementing interprofessional education and practice (IPEP) strategies that extend across the learning continuum requires that institutions create a structure to support effective and organized coordination among interested administrators, faculty and staff. The University of Virginia Center for Academic Strategic Partnerships for Interprofessional Research and Education (UVA Center for ASPIRE) was formally established in 2013 following five years of dramatic growth in interprofessional education at the School of Nursing, School of Medicine and the UVA Health System. This guide briefly describes the steps that led to the creation of the Center and the key lessons learned that can guide other institutions toward establishing their own IPE centers.

An interprofessional workshop for students to improve communication and collaboration skills in end-of-life care.

Interprofessional care is critical for patients at the end of life (EOL), but programs to teach communication skills to medical and nursing students are rare. The aims of this study were to determine whether an interprofessional workshop improves (1) student attitudes toward teamwork and (2) self-efficacy for communicating in difficult situations. Nursing and medical students attended a workshop with collaborative role play of an EOL conversation. Before the workshop, students showed different attitudes toward teamwork and collaboration and varying levels of confidence about communication skills. After the workshop, both groups reported more positive attitudes toward teamwork but a mixed picture of confidence in communication. Experiential interprofessional education workshops enhance perceptions about the benefits of teamwork, but further teaching and evaluation methods are needed to maximize the effectiveness.

Designing and evaluating an effective theory-based continuing interprofessional education program to improve sepsis care by enhancing healthcare team collaboration.

Continuing interprofessional education (CIPE) differs from traditional continuing education (CE) in both the learning process and content, especially when it occurs in the workplace. Applying theories to underpin the development, implementation, and evaluation of CIPE activities informs educational design, encourages reflection, and enhances our understanding of CIPE and collaborative practice. The purpose of this article is to describe a process of design, implementation, and evaluation of CIPE through the application of explicit theories related to CIPE and workplace learning. A description of an effective theory-based program delivered to faculty and clinicians to enhance healthcare team collaboration is provided. Results demonstrated that positive changes in provider perceptions of and commitment to team-based care were achieved using this theory-based approach. Following this program, participants demonstrated a greater appreciation for the roles of other team members by indicating that more responsibility for implementing the Surviving Sepsis guideline should be given to nurses and respiratory therapists and less to physicians. Furthermore, a majority (86%) of the participants made commitments to demonstrate specific collaborative behaviors in their own practice. The article concludes with a discussion of our enhanced understanding of CIPE and a reinterpretation of the learning process which has implications for future CIPE workplace learning activities.

Development and validation of a collaborative behaviors objective assessment tool for end-of-life communication.

CONTEXT: Helping families make end-of-life decisions requires close collaboration between physicians and nurses. However, medical and nursing students have little formal training in how to collaborate in this task, and few instruments are available to measure collaborative behaviors. OBJECTIVES: The objective of this project was to develop and validate observational assessment tools to measure specific interprofessional competencies in medical and nursing students related to end-of-life discussions. DESIGN: A literature search for evidence-based guidelines and competencies and focus groups with an expert panel of nurses and physicians were used to outline best collaborative practice behaviors for nurses and physicians in an end-of-life decision making simulation. The panel used these practice-behavior checklists to rate videotaped student scenarios and then refined the checklists for validity and clarity until the tools had acceptable inter-rater reliability. SETTING: The setting was a workshop teaching end-of-life communication to third-year nursing and medical students. MEASUREMENTS: Inter-rater reliability was measured using percent agreement and kappa; internal consistency was measured using Cronbach's alpha. RESULTS: Collaborative behaviors objective assessment tools (CBOATs) for nursing and medical students were developed. For the medical CBOAT we found 85% agreement between raters, with an overall kappa of 0.744 and Cronbach's alpha of 0.806. For the nursing CBOAT there was 81% agreement, with a kappa of 0.686 and Cronbach's alpha of 0.845. CONCLUSIONS: Development of an end-of-life CBOAT clarified the important collaborative behaviors needed by physician and nurse. The resulting instruments provide a helpful guide for teaching interprofessional sessions related to the end of life and measuring student outcomes using an objective strategy.