Promoting Quality Improvement in Primary Care Through a Longitudinal, Project-Based, Interprofessional Curriculum.

Introduction: Health professionals must demonstrate competencies in quality improvement (QI) and interprofessional (IP) practice. Yet few curricula are designed to address these competencies in an integrated, longitudinal way. Our experiential IP QI curriculum addresses this gap. Methods: The IP QI curriculum was part of a San Francisco VA Health Care System training program for second-year internal medicine residents and adult gerontology primary care nurse practitioner students, pharmacy residents, and postdoctoral psychology fellows. Trainees worked in mentored IP teams to select, design, implement, evaluate, and present a project as part of a 9-month curriculum. Teaching methodologies included didactics and project-based skills application. Curriculum evaluation included trainees' QI knowledge and skills self-assessments, trainee satisfaction, mentor appraisals, and project results and impact assessments. Results: From 2011-2012 to 2017-2018, 242 trainees completed the curriculum and 41 QI projects. Trainees reported high satisfaction with the introductory sessions (M = 4.4, SD = 0.7). They also reported improvement in comfort with QI knowledge and skills by the curriculum's completion. QI mentors (n = 23) observed growth in trainees' QI knowledge and skills, felt confident in trainees' ability to orchestrate a QI initiative, and believed their mentored QI projects added value to the organization. Thirty-eight projects resulted in system modifications. Discussion: This IP QI curriculum offers team-based, workplace experiences for trainees to learn and apply QI knowledge and skills. Leading factors for successful implementation included attention to team-building and faculty development. Challenges included reliably collecting evaluation data, accurately measuring ongoing systems changes, and variable trainee engagement.

Promoting Role Clarity for Health Professional Students Participating in an Interprofessional Behavior Change Counseling Workshop.

Interprofessional role clarity is linked to improving team collaboration and clinical care, yet there are barriers to implementing interprofessional curricula targeted to learner achievement of this competency. A behavior change counseling skills workshop for first-year advanced practice nursing (APN) (n=153) and third-year pharmacy (PharmD) (n=127) students was modified to include learning experiences for enhancing interprofessional role clarity. Students rated the importance of each profession's contributions in nine patient care activities before and after the workshop. APN and PharmD students increased their ratings of the merit of each profession in counseling patients in several care activities. Findings suggest that providing interprofessional students an opportunity to learn core skills together can also foster an understanding of each other's professional roles and responsibilities.

Veteran Affairs Centers of Excellence in Primary Care Education: transforming nurse practitioner education.

To integrate health care professional learners into patient-centered primary care delivery models, the Department of Veterans Affairs has funded five Centers of Excellence in Primary Care Education (CoEPCEs). The main goal of the CoEPCEs is to develop and test innovative structural and curricular models that foster transformation of health care training from profession-specific "silos" to interprofessional, team-based educational and care delivery models in patient-centered primary care settings. CoEPCE implementation emphasizes four core curricular domains: shared decision making, sustained relationships, interprofessional collaboration, and performance improvement. The structural models allow interprofessional learners to have longitudinal learning experiences and sustained and continuous relationships with patients, faculty mentors, and peer learners. This article presents an overview of the innovative curricular models developed at each site, focusing on nurse practitioner (NP) education. Insights on transforming NP education in the practice setting and its impact on traditional NP educational models are offered. Preliminary outcomes and sustainment examples are also provided.

Shared faculty governance: a decision-making framework for evaluating the DNP.

The concept of shared governance was used to frame the dialogue and decision-making process around the Doctor of Nursing Practice (DNP) at a leading School of Nursing. This article reports the process used to support dialogue around the DNP so that an informed decision could be made. The shared governance process promoted reflective conversation within the entire faculty and, in the end, supported the decision-making related to the DNP.

Meeting a primary care challenge in the United States: chronic illness care.

Leading health care experts in the United States have stated that the greatest primary care challenge today is meeting the complex needs of patients with chronic illness/long-term conditions or impairment.To address this challenge, there is a need for health care system redesign that requires a multidisciplinary team approach, including active participation from professional nurses. In particular, it is essential for advanced practice nurses to provide leadership in health systems design for which they are specifically trained and experienced. In this article, the primary care challenge related to chronic illness care management is addressed. Future implications for community-based, chronic illness care delivery and the education of future health care providers with a focus on advanced practice nurses will also be discussed.