Higher Learning Commission

A Curriculum Innovation for Interprofessional Education

Rush University

Overview of the Quality Initiative

The purpose of this Quality Initiative (QI) is to introduce a staged integration of interprofessional education (IPE) across the academic programs of Rush University. The overall goal is to prepare a collaborative practice ready workforce by educating future health care professionals to function in interprofessional patient centered-teams. The QI reflects the strategic goals and initiatives of the institution that are aimed at promoting and expanding IPE and practice (IPP). It is responsive to the “Triple Aim” of health care reform and to the National Institute of Medicine’s quest to promote interprofessional and team-based health care. The QI expands pilot work conducted with the support of a Health Resources and Service Administration (HRSA) grant and is part of a longer strategic initiative that aims to fulfill Rush’s vision for interprofessional practice: “Rush will be nationally recognized as a leader in highly effective patient-centered team care and the inter-professional education of health professionals.”

The project incorporates best practices of IPE as outlined by Bridges, et. al. (2011) and builds on the core competency domains of IPE developed by the Interprofessional Education Consortium (IPEC, 2011). Year one of the QI involves integrating a structured four-phased IPE curriculum into early adopter academic programs. Students will transition through faculty-guided structured learning activities that include engagement of health mentors, completion of online interactive learning modules, participation in review workshops, and participation in Team Observed Simulation Clinical Exercises (TOSCEs). In year two, the initiative will be extended to include more adopter programs and students. Further in year two, faculty will begin developing strategies on how to best help students transfer the foundational knowledge gained in the classroom portion of this program to the practice learning environment. Process and outcome evaluation data obtained during this two year period will inform decisions on how best to integrate IPE into all academic programs of the university.

Key objectives to be achieved over the next two years of this initiative include:

  • Integrate a four-phased IPE curriculum into early adopter academic programs
  • Increase the numbers of faculty who champion and promote integration of IPE into their courses and curricula
  • Develop strategies for helping students transfer foundational IPE competencies into the clinical arena

Primary accountability for implementing and evaluating the IPE quality initiative will be assumed by the project directors and the IPE Coordinating Committee that report directly to the university president and provost. The IPE initiative has been approved by the university curriculum committees and major decision making bodies that include the University Council and Board of Governors. Funding and support of the project has been granted by the university leadership group, including the president, provost, and college deans. Early adopter programs have been identified and faculty champions have been prepared through a series of development programs and workshops.

Rush University is a private, not-for-profit university that is focused entirely on health care and is totally integrated within an academic medical center, Rush University Medical Center. The university is comprised of four colleges: Rush College of Medicine, College of Nursing, College of Health Sciences, and the Graduate College. The highly integrated management and governance structure at Rush allows Rush University to address educational and research opportunities in the setting of a state-of-the-art learning laboratory of a major medical center.

Scope, Significance and Context

The National Institute of Medicine Committee on Quality of Health Care in America (IOM, 2011) suggests that healthcare professionals working as interprofessional teams more effectively communicate and address complex and challenging health care needs. In 2011, an expert panel of health educators sponsored by IPEC created the core competency domains that serve as a framework for preparing future health care workers to function in team-based, patient centered, and collaborative care. These domains include teams and teamwork, communication, values and ethics, and roles and responsibilities. Each domain describes the knowledge; skills and values students must attain to be proficient in team-based, collaborative care.

Interprofessional education (IPE), as defined by the World Health Organization (WHO, 2010), “occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes”. Educating future health care providers within an interprofessional team based context addresses the “Triple Aim” of health care reform which calls for healthcare that is patient centered, high value/low cost, and directed at improving population health. Many of the health sciences program accrediting bodies have echoed the call for IPE by including criteria that require evidence of IPE in curricula joined with authentic learning experiences.

Enhancing IPE at Rush through this Quality Initiative affirms our mission to provide “outstanding health sciences education . . . focused on the promotion and preservation of the health and well-being of our diverse communities.” By introducing an institution-wide, cohesive, organized and systematic approach to delivering IPE, Rush University will enhance the quality and value of its educational programs by preparing its graduates for real-life work experiences in which diverse professionals work together in a coordinated manner to enhance patient safety and quality, improve clinical outcomes, and facilitate patient-centered care. Students who participate in IPE will develop the core competencies for collaborative practice in reality-based clinical and research environments guided by expert educators, clinicians and faculty role-models.

The IPE initiative will address two institutional evaluation findings. In a recent survey, students indicated that: 1) they were unable to delineate and describe the components of interprofessional education in their program curricula; and 2) desired more IPE opportunities and experiences. Further, a curriculum analysis revealed that faculty differ in their understanding and approach to IPE; clinical experiences often lack the intentionality required to foster interprofessional learning; and interprofessionalism and related concepts most often are taught to students in a siloed approach.

Purpose and Goals

The purpose of this QI is to introduce a staged integration of IPE across the academic programs of Rush University. Although many institutions have integrated aspects of IPE, none as reported in the literature have integrated the type of multi-faceted approach proposed by Rush. In the model depicted in Figure 1, students will be introduced to the core competencies of interprofessional practice through five on-line interactive learning modules. Core competencies are further developed and reinforced through structured team-based curricular experiential learning activities. Knowledge and skills are expanded as individual programs incorporate more advanced leadership competencies in a purposeful manner to strengthen interprofessional learning and collaborative practices.

RushUniversity Fig1

Objectives and Milestones

The president of the university, provost, and college deans are committed to fulfilling our vision to be nationally recognized as a leader in IPE. We believe that by linking interprofessional education and practice we can achieve Rush’s vision for interprofessional practice. Within that context, this project is part of a longer initiative that will extend beyond the two year QI period. Project objectives and milestones during this QI period include:

Year 1

  • Integrate a four-phased IPE curriculum into early adopter academic programs
    • Engage approximately 33% of first year students in the IPE program (300-350 students)
    • Incorporate five online learning modules into selected courses offered within the nine early adopter programs
    • Offer Health Mentor sessions to teams of 3-5 students each representing at least 2 disciplines
    • Present 4 review workshops to student groups of approximately 6 students each representing at least 2 disciplines each
    • Direct Team Observed Simulation Clinical Experiences (TOSCEs) for participating student teams
    • Evaluate all components of the structured IPE program sequence to inform quality improvement decisions prior to extending the project
  • Increase the number of faculty who champion and promote integration of IPE into their courses and curricula
    • Create faculty development opportunities
    • Provide faculty web-based resources and tools that encompass best practices for implementing IPE
    • Develop strategies for recognizing and supporting faculty efforts and accomplishments relative to IPE activities

Year 2

  • Increase the number of adopter programs and participating students
    • Increase the number of participating students to 67% of the new matriculating cohort
    • Expand the number of adopter programs by at least 3
    • Develop strategies to integrate IPE into programs not engaged in direct patient care
    • Develop strategies on how best to incorporate distance education students
  • Develop strategies for how to best help students transfer knowledge gained in the classroom to the clinical learning environment
    • Engage faculty of early adopter programs in modifying clinical experiences and student performance criteria to include team-based observations and interactions

Evidence of Commitment to and Capacity for Accomplishing and Sustaining the Initiative

Bridges, et al. (2011), in a review of best practice models for IPE, recommended factors essential to IPE success: Administrative support; interprofessional programmatic infrastructure; committed, experienced faculty; and acknowledgement of student efforts.

Administrative support and strategic planning

Introducing a structured IPE program at RU is both aspirational and responsive to the practice and research environments in which our students, graduates, faculty and staff learn and work. IPE as the HLC Quality Initiative was first discussed by the University Council, a faculty governance committee of RU, in 2014. During this time, two events transpired that helped launch the IPE initiative.

Two professors from the College of Nursing received a Health Resources and Services Administration (HRSA) grant award to support a pilot project entitled Advanced Nursing Education: Interprofessional Education Pediatrics through Aging (IPEPA). Their pilot work serves as the basis for Rush’s IPE model and provides many of the resources and tools that will be used in the implementation of this initiative. These professors will continue their work as project directors for the IPE initiative and serve as chairpersons for the IPE Coordinating Committee.

Concurrently, Rush University Medical Center and Rush University engaged in updating their respective strategic goals. Administrators and faculty from across the university, including deans of all the colleges, were actively involved in developing the strategic goals, many of which support IPE:

  • Provide resources and opportunities for collaborative learning and discovery
  • Design innovative curricula, programs, and degrees that meet the present and future needs of health care delivery
  • Ensure that all students, faculty, and staff acquire leadership and collaboration competencies
  • Support team-based learning and practice

Specified in the strategic planning documents is support for the IPE curriculum model that grew out of the IPEPA grant. The curriculum model was presented to and approved by multiple administrative and faculty groups within the university: University Council; university president and provost; college deans; Board of Governors; college and university curriculum committees; and university faculty and student groups. Subsequently, the university president approved a budget and allocated funds to support IPE associated activities. The budget accounts for project directors’ and project manager’s salaries and 10% release time for faculty facilitators; outside consultations; standardized patients; technology and analytic support; food and refreshments; parking for the health mentors; and project supplies. Outside consultants from Jefferson University and the University of Washington, two leaders in IPE, were invited to present best practices on IPE to faculty, administrators and students. Funds were provided to support an IPE faculty retreat to discuss implementation and evaluation strategies. An IPE Coordinating Committee, led by the project directors, was formed to plan and coordinate integration of learning activities across programs. The University Curriculum Committee was charged with monitoring and evaluating IPE related student learning outcomes, teaching strategies and assessments.

Interprofessional programmatic infrastructure

Rush University (RU), with its nearly 25 health sciences programs, and Rush University Medical Center (RUMC) provide a rich environment for cross-disciplinary learning. As part of an academic medical center, RU is uniquely poised to promote innovative IPE models and experiential learning opportunities through its practitioner-teacher framework; its affiliations with its parent organization, RUMC; and its many partnerships with community-based health care organizations.

The structured portion of the IPE curriculum, designed to be implemented during the first year of an academic program, will be sequenced as described in Figure 2. Students will begin the IPE experience by working on an interprofessional team that includes patients (health mentors) who are volunteers from our communities and are dealing with one or more chronic health conditions. The purposes of this guided experience are to 1) have students establish a team identity concurrent with their discipline-specific identity and 2) understand the patient’s perspective of living with and managing chronic conditions. A cadre of health mentor volunteers has already been established and pilot feedback for this experience from both students and health mentors has been excellent.

RushUniversity Fig2

On-line learning modules supported by our BlackBoard™ learning management system and instructional design team were developed with outside consultation, vetted by an interprofessional team of faculty experts, and approved by the IPE Coordinating Committee and the University Curriculum Committee. Each module focuses on a core competency identified by IPEC: teams and collaborative practice; roles and responsibilities; communication; patient-centered care, values and ethics; and teamwork. Small groups of students from multiple programs will be assigned as interprofessional teams to complete the on-line interactive learning activities associated with each module. Early adopter programs have identified courses into which these modules can be inserted.

In addition, students will participate in a structured review workshop and in Team Observed Simulation Clinical Experiences (TOSCEs) in a newly built state-of-the art simulation center. The purposes of the simulations are to have student teams 1) learn how to support patients as they manage their chronic conditions and 2) discover through teamwork and communication how the social determinates of health effect patient outcomes. Student teams are observed during their interaction with a standardized patient, debriefed after the session, and given the opportunity to re-enact the exercise incorporating feedback from faculty. Results of the simulation pilot have demonstrated that this is an effective approach to helping students gain insights into and change their behavior as team members.

Program directors for each discipline have participated in the planning of the IPE experiences and a project manager has been assigned responsibility for organizing and coordinating the activities to accommodate the schedules of the programs and students, confirm health mentor availability, and secure space to accommodate the learning activities.

Committed, experienced faculty

The project directors for this initiative are recognized experts in IPE, having secured a federal grant for IPE, serving as IPE consultants to internal and external groups, and disseminating their work through publications and presentations. Over 350 committed Rush faculty from 18 different disciplines have participated in workshops dedicated to best IPE practices. Fifteen faculty champions will participate in the program as facilitators for the student review workshops, interactive on-line learning modules, and health mentor activities during the initial roll out of the program. In addition, the project directors, in collaboration with the Office of Faculty Affairs will develop strategies for recognizing and supporting faculty efforts and accomplishments relative to IPE activities. Further, the project directors will engage our IT and marketing teams to help disseminate web-based educational resources to guide faculty in implementing best practices of IPE.

Acknowledged student efforts

Students will receive a Certificate of Completion without official academic credit for participation during this two year initiating period. The Certificate of Completion acknowledges student’s efforts and can be incorporated into their academic portfolios. Transcripts will also designate that students completed the IPE curriculum sequence. Going forward, strategies will be developed on how best to acknowledge student participation and effort.

Evaluation Plan

Continuous quality improvement and refining of the initiative will be based on formative and summative evaluation of process and outcome measures. The table in Appendix A depicts the major components of the IPE plan. The primary process evaluation measure will be determining the extent to which the program is implemented as planned. Nine early adopter programs and approximately 300 students are expected to participate in the first year of this QI: biotechnology, clinical nutrition, medical laboratory science, occupational therapy, physician assistant, speech language pathology, medicine, nursing and pharmacy. Because Rush does not have its own pharmacy program, we have partnered with Roosevelt University at Chicago to include its pharmacy students. Over successive years, it is expected that the number of programs and the number of participating students will gradually increase until a full complement is achieved.

Specific aspects of the implementation phase that will be evaluated include:

  • effectiveness of program sequence from health mentor through TOSCEs. Does the sequence/order of the program optimize transfer of knowledge and patient-centered team skills through each successive stage?
  • faculty and student work effort for completion of all activities. Is the predicted time and work effort accurate?
  • adequacy of human, physical, and financial resources. Do the allocated resources fulfill the needs of the program? Is the projected cost of the program accurate?
  • level of faculty participation: How many faculty have purposefully incorporated modular IP content into additional class and clinical experiences?

Data sources will include faculty focus groups, budget reports, and student performance data.

Outcome evaluation encompasses assessment of students’ knowledge, skills and attitudes relative to the core competencies and interprofessional practice. Interprofessional student learning outcomes were developed by the IPE Coordination Committee, vetted by an interprofessional team of faculty and approved by the University Curriculum Committee. They reflect the four IPEC domains. Students participating in the IPE program will:

  • engage diverse professionals to complement one’s own professional experiences in investigating, developing, and implementing strategies focused on improving health and health care outcomes;
  • work in an ethical respectful manner with all members of the health care team responsible for investigating, developing, and delivering patient-centered care;
  • communicate with clarity, confidence and respect in encouraging ideas and opinions of other team members to ensure a common understanding of information, treatment, and health/health care decisions; and
  • apply leadership practices that support collaborative practice, team effectiveness, and patient-centered care.

Student learning will be evaluated through multiple touch points framed by Kirkpatrick’s domains for evaluation (2002):

  • reaction: learner’s views on the learning experience and its interprofessional nature;
  • modification of attitudes/perceptions: changes in reciprocal attitudes or perceptions between participant groups; changes in perception or attitudes towards the value and/or use of team approaches to caring for specific clients; and
  • acquisition of knowledge/skills: including knowledge and skills linked to interprofessional collaboration.

Evaluation measures will include direct and indirect methods with standardized and authentic assessments: self-reflections; pre-post examinations; direct observation; and focus groups. Formative and summative assessments are embedded in the design of the five on-line learning modules and TOSCEs. Students are required to respond to a series of questions throughout the module for which they receive instant feedback on the accuracy of their response and the related rationale. Debriefing sessions during TOSCEs provide students feedback on their team participation. The Jefferson Team-Work Observation Guide (JTOG) is a standardized assessment tool that will be used to evaluate team-participation, knowledge acquisition, and self-reflection (Speakman, G. et al. (2014). The McMasters-Ottawa Tool will be used to evaluate performance during the TOSCE (Solomon, et al. (2011). Both are tools with established validity and reliability. Project directors are in the process of selecting an appropriate attitude scale.

Project Timeline

Much of the preliminary work has already been completed that includes: developing on-line learning modules; securing a cadre of health mentor volunteers; selecting early adopter courses and programs; identifying faculty facilitators; selecting evaluation tools; securing a project budget; and scheduling student teams and project events through December, 2016.

The calendar of events that chronicles the staging of the IPE program was developed by the IPE project directors and project manager in collaboration with the academic program directors. The calendar accounts for variations in the academic calendars across colleges, scheduled major exams and assignments, clinical schedules and major program events, and break weeks.

Year 1:

  • September –March: Integrate the 4 phased IPE curriculum into early adopter programs
    • June – August: Recruit, train and schedule health mentors
    • September: Project directors (PD) will host facilitator training and brown bag question and answer sessions.
    • September-November: Student teams each will meet with their Health Mentors for a two hour session.
    • September-December: Students will complete on-line facilitator guided interactive learning modules embedded in selected courses.
    • January—February: Project faculty and facilitators will conduct review workshops for students to reinforce learning that occurred through the health mentor program and learning modules.
    • March: Project faculty and facilitators will conduct Team Observed Clinical Simulation Exercises.

  • January-March: PDs and IPE Coordinating team will identify at least 3 new adopter programs to be added in year 2 of the project.

  • February-June: PD and IPE Coordinating team in collaboration with the Office of Institutional Research, Assessment and Accreditation will analyze evaluation data and modify program as needed prior to the next implementation phase.

  • June-August: PDs will submit progress report to president and Board of Governors; begin scheduling events for year 2 of the initiative.

Year 2:

  • September-March: Implement the 4 phased IPE curriculum to the next cohort of incoming students.

  • March-August: PDs will analyze data from the two year initiative and submit final reports to HLC, university president and Board of Governors.

  • June-August: PD, IPE Coordinating Team, program faculty and facilitators will begin discussing strategies for transferring IPE into the clinical learning environment.

Challenges

A challenge for the upcoming year will be scheduling activities in light of different academic calendars across the university. Creative scheduling has helped circumvent this issue. Beginning in the Fall of 2017, all colleges will be on the same academic calendar permitting easier scheduling of activities.

Another challenge is administering the program to distance students. The IPE project director has begun piloting how best to integrate distance students with a small group of pediatric nurse practitioner students who will engage virtually with all components of the learning activities.

A major challenge going forward in years 3-5 of the project will be that of transitioning IPE to the clinical learning environment, an accomplishment yet to be realized by most institutions engaging in IPE. Despite the many high functioning integrated practice units at Rush University Medical Center and across its network of satellite facilities, most interprofessional practices exist in isolation from one another with insufficient opportunities for students, faculty and staff to learn together and maximize value. Towards the end of year two of this initiative, the IPE Coordinating Committee and faculty will begin discussing strategies for how best to transition IPE into the clinical learning environment.

References

Bridge, D., Davidson, R., Odegard, P., Maki, I., Tomkowiak, J. (2011). Interprofessional collaboration: three best practice models of interprofessional education. Medical Education Online,16:6035 – DO!:10.3402/meo.v1610.6035.

George, D., Speakman, E., Smith, K., Lyons, K., & Giordan, C. (2014). Jefferson Teamwork Observation Guide (JTOG): A Pilot Project. Jefferson Center for Interprofessional Education (JCIPE) Interprofessional Education and Care e-Newsletter, 5(2).

Institute of Medicine Committee on Quality of Health Care in America, editor. Crossing the Quality Chiasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001.

Kirkpatrick, D.L. (1967). Evaluation of training. in: R.L. Craig & L.R. Bittel LR (Eds.), Training and Development Handbook (87-112), New York: McGraw-Hill.

IPEC (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Interprofessional Education Collaborative Expert Panel.

Solomon, P., Marshall, D., Boyle, A., Burns, S., Casimiro, L.M., Hall, P., & Weaver, L. (2011). Establishing face and content validity of the McMaster-Ottawa team observed structured clinical encounter (TOSCE). Journal of Interprofessional Care, 25 (4), 302-304

Appendix

RushUniversity Appendix1

RushUniversity Appendix2

RushUniversity Appendix3

 

Institution Contact

Rosemarie Suhayda, Associate Provost, Institutional Research, Assessment and Accreditation, and Associate Professor and Director of Evaluation, College of Nursing

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