May 26, 2011 — Effective collaboration among health care providers is an essential component of high-quality patient care. To better prepare its students for this partnership, the University of Virginia's schools of Nursing and Medicine have pioneered interprofessional education initiatives that bring nursing and medical students together in common learning experiences.
A $746,000 grant from the New York-based Josiah Macy Jr. Foundation will help to strengthen, expand and assess interprofessional education opportunities for nursing and medical students, while creating best practices for collaborative patient care and developing new models for other schools to follow.
Initial interprofessional education efforts at U.Va. have focused on cultivating shared knowledge and attitudes through course work, clinical training and community service projects. These efforts have emphasized an understanding of the respective roles of nurses and physicians and the importance of building mutual trust and respect.
One workshop, for example, immerses nursing and medical students in difficult conversations surrounding end-of-life care. Students learn the importance of team-based care as they assist in mock cases that portray families facing complex, end-of-life decisions.
The Macy Foundation grant will enable the schools to integrate teamwork training into expanded simulated clinical settings, with the goal of understanding how collaboration works successfully for a range of patient populations (pediatric, adult, geriatric), illnesses (chronic and acute) and environments (inpatient, intensive care, outpatient, transition-to-home care). The grant will support the development and implementation of new faculty training programs, simulated cases and course work, in addition to new types of assessment tools for evaluating interprofessional education behaviors and competencies.
"New nurses and physicians will find themselves in many complex settings," Nursing School dean Dorrie K. Fontaine said. "With this generous grant from the Macy Foundation, U.Va. is well-positioned to transform our program and create new best practice models and assessment methods that will, ultimately, lead to better care for patients here and elsewhere."
The task of putting this vision into practice is led by nationally recognized U.Va. teaching scholars, including Dr. Valentina Brashers, professor of nursing and founder and co-chair of U.Va.'s Interprofessional Education Initiative; Dr. Leslie Blackhall, expert clinician in interprofessional palliative end-of-life care; Jeanne Erickson, expert clinician in interprofessional oncology care; and John Owen, expert in educational evaluation.
"We have an opportunity to prepare future generations of U.Va. nurses and physicians to collaborate successfully in providing high-quality, patient-centered care in any health care setting," Brashers said. "This grant will enable us to build upon innovative IPE programs pioneered by Drs. Blackhall, Erickson and Owen by expanding the number of IPE offerings, enhancing content overall and incorporating a team approach into more of the curriculum."
According to Brashers, U.Va. faculty will create new interprofessional experiences using simulated clinical cases. One project, for example, focuses on caring for children with Duchenne muscular dystrophy in an outpatient setting. Since the disorder is a chronic, progressive disease, it requires effective care from multiple health care disciplines. Research has shown that coordinated interprofessional practice is an important factor in managing this complex illness. With Macy funding, U.Va. will develop a simulated interprofessional Duchenne muscular dystrophy care conference scenario involving parent and child roles that can be used to engage physicians, nurses and other clinicians. Using this mock scenario and research data, U.Va. nursing and medical teaching experts will develop measurable best practices that can be taught and reinforced in student interactions.
Since 2009, Fontaine and Dr. Steven T. DeKosky, vice president and dean of the School of Medicine, have worked toward establishing interprofessional educational experiences and assessing their effectiveness. Their Interprofessional Education Initiative has contributed to change in the institutional culture at both schools, and in other parts of the Health System. Faculty have engaged in professional development, research opportunities and the creation of new interprofessional education experiences at the undergraduate, graduate and continuing education levels. Students begin learning about professional roles and teamwork competencies beginning in their first years.
"The Macy grant will allow the two schools to further integrate our curricula in ways that strengthen student learning and ultimately patient care," DeKosky said. "We recognize that the whole is much greater than the sum of its parts, so by integrating the work of the Nursing and Medical schools we hope to create a model that can be used by a wide range of health care organizations."
"We have good evidence that health care delivered in teams is more efficient and leads to better outcomes for patients," Macy Foundation president Dr. George E. Thibault said. "By providing opportunities for students from different health professions to work together in classroom and clinical settings, we can build a foundation for team-based care and put practitioners on a path to working together in a way that we know leads to higher quality care, reduces medical errors and meets the public's needs.
"This is one of several grants and programs we are sponsoring across the nation with a goal of making interprofessional education a core activity for all health professional students. Lessons learned from the unique activities in this grant will not only improve the education of students at U.Va., but will also contribute to this national movement."