Improving the Interprofessional Practice, Knowledge, and Skills of Health Professions Students through an Interactive Course in Gerontology
DOI:
https://doi.org/10.18060/23682Keywords:
Interprofessional education, geriatrics, competencyAbstract
Interprofessional, collaborative health care is the ideal standard in geriatrics. Students’ interprofessional practice skills are limited in typical siloed education. An experiential, team-based geriatrics course was designed to improve health professions (HP) students’ knowledge, skills, and attitudes about interprofessional practice. Students (n=209) from dentistry, medicine, nursing, nutrition, occupational therapy, pharmacy, physician assistant, social work, and speech-language pathology were assigned to interprofessional (IP) and medical-student only teams. The Interprofessional Collaborative Competency Attainment Survey-Revised (ICCAS-R) was administered pre- and post-course, along with program evaluations. Seventy percent of students completed both pre- and post-surveys. ICCAS-R scores were analyzed comparing the impact of training for medical students (n=78) on IP teams and remaining HP students (n=58). Students rated themselves as improved on all six ICCAS-R subscales (paired t-tests, p < 0.05). Sixty-nine percent rated themselves as better able to collaborate interprofessionally. A competitive team-based learning exercise using gamification was rated as the most authentic skill-building interprofessional activity. Experiential learning where students worked with the same team helped to build interprofessional and teamwork skills. Findings will be used to improve authenticity of the clinical and teamwork content, increase the use of gamification as a teaching technique, and refine students’ practice of IP teamwork competencies.
References
Ashman, J. J., Rui, P., & Okeyode, T. (2019). Characteristics of office-based physician visits, 2016. NCHS Data Brief, 331. Atlanta, GA: Centers for Disease Control. https://www.cdc.gov/nchs/data/databriefs/db331-h.pdf
Archibald, D., Trumpower, D., & MacDonald, C. J. (2014). Validation of the interprofessional collaborative competency attainment survey (ICCAS). Journal of Interprofessional Care, 28(6), 553-558. https://doi.org/10.3109/13561820.2014.917407
Baker, D. P., Day, R., & Salas, E. (2006). Teamwork as an essential component of high-reliability organizations. Health Services Research, 41(4), 1576-1598. https://doi.org/10.1111/j.1475-6773.2006.00566.x
Baker, D. P., Gustafson, S., Beaubien, J., Salas, E., & Barach, P. (2005). Training teams: Medical teamwork and patient safety: The evidence-based relation. Agency for Healthcare Research and Quality. https://archive.ahrq.gov/research/findings/final-reports/medteam/medteamwork.pdf
Barker J. (2007). Error reduction through team leadership: What surgeons can learn from the airline industry. Clinical Neurosurgery, 54, 195-199.
Biehle, L., & Jeffres, M. (2018). Play games and score points with students. The Clinical Teacher, 15(6), 445-450. https://doi.org/10.1111/tct.12763
Borson, S., Scanlan, J. M., Watanabe, J., Tu, S. P., Lessig, M. (2005). Simplifying detection of cognitive impairment: Comparison of the Mini-Cog and Mini-Mental State Examination in a multiethnic sample. Journal of the American Geriatrics Society, 53(5), 871-874. https://doi.org/10.1111/j.1532-5415.2005.53269.x
Brandt, B., Lutfiyya, M. N., King, J. A., & Chioreso, C. (2014). A scoping review of interprofessional collaborative practice and education using the lens of the Triple Aim. Journal of Interprofessional Care, 28(5), 393-399. https://doi.org/10.3109/13561820.2014.906391
Canadian Interprofessional Health Collaborative. (2010, February). A national interprofessional competency framework. Vancouver, BC: Author. http://ipcontherun.ca/wp-content/uploads/2014/06/National-Framework.pdf
Centers for Disease Control. (2017). Assessment: Measuring orthostatic blood pressure. https://www.cdc.gov/steadi/pdf/STEADI-Assessment-MeasuringBP-508.pdf
Cerra, F. B., & Brandt, B. F. (2015). The growing integration of health professions education. In S. Wartman (Ed.), The transformation of academic health centers: Meeting the challenges of healthcare’s changing landscape (pp. 81-90). Elsevier. https://doi.org/10.1016/B978-0-12-800762-4.00009-8
Chakraborti, C., Boonyasai, R. T., Wright, S. M., & Kern, D. E. (2008). A systematic review of teamwork training interventions in medical student and resident education. Journal of General Internal Medicine, 23(6), 846-853. https://doi.org/10.1007/s11606-008-0600-6
Collamati, A., Martone, A. M., Poscia, A. Brandi, V., Celi, M., Marzetti, E., Cherubini, A., & Landi, F. (2016). Anticholinergic drugs and negative outcomes in the older population: from biological plausibility to clinical evidence. Aging Clinical and Experimental Research, 8(1), 25-35. https://doi.org/10.1007/s40520-015-0359-7
Coupland, C. A. C., Hill, T., Denning, T, Moriss, R., Moore, M., & Hippisley-Cox, J. (2019). Anticholinergic drug exposure and the risk of dementia: A nested case-control study. JAMA: Internal Medicine, 179(8), 1084-1093. https://doi.org/10.1001/jamainternmed.2019.0677
Covinsky, K. E., Pierluissi, E., & Johnston, C. B. (2011). Hospitalization-associated disability “She was probably able to ambulate, but I’m not sure.” JAMA, 306(16), 1782-1793. https://doi.org/10.1001/jama.2011.1556
Doran, G. T. (1981). There’s a S.M.A.R.T. way to write management’s goals and objectives. Management Review, 11, 35-36. https://community.mis.temple.edu/mis0855002fall2015/files/2015/10/S.M.A.R.T-Way-Management-Review.pdf
Felton, M., Tannenbaum, C., McPherson, M. L., & Pruskowski, J. (2019). Communication techniques for deprescribing conversations #369. Journal of Palliative Medicine, 22(3), 335-336. https://doi.org/10.1089/jpm.2018.0669
Fried, L. P., Bandeen-Roche, K., Williamson, J. D., Prasada-Rao, P., Chee, E., Tepper, S., & Rubin, G. S. (1996). Functional decline in older adults: Expanding methods of ascertainment. The Journals of Gerontology: Series A, 51A(5), M206–M214. https://doi.org/10.1093/gerona/51a.5.m206
Gottlieb, B. H., & Bergen, A. E. (2010). Social support concepts and measures. Journal of Psychosomatic Research, 69, 511-520. https://doi.org/10.1016/j.jpsychores.2009.10.001
Greiner, A. C., & Knebel, E. (Eds.). (2003). Health professions education: A bridge to quality. National Academies Press. https://www.ncbi.nlm.nih.gov/pubmed/25057657
Gentry, S. V., Gauthier, A., Ehrstrom, B., L., Wortley, D., Lilienthal, A., Car, L. T., Dauwels-Okutsu, S., Nikolaou, C. K., Zary, N., Campbell, J., & Car, J. (2019). Serious gaming and gamification education in health professions: A systematic review. Journal of Medical Intern Research, 21(3), e12994. https://doi.org/10.2196/12994
Guraya, S. Y., & Barr, H. (2018). The effectiveness of interprofessional education in healthcare: A systematic review and meta-analysis. Kaohsiung Journal of Medical Sciences, 34(3), 160-165. https://doi.org/10.1016/j.kjms.2017.12.009
Hall, P., & Weaver, L. (2001). Interdisciplinary education and teamwork: A long and winding road. Medical Education, 35, 867-875. https://doi.org/10.1046/j.1365-2923.2001.00919.x
Health Professions Accreditors Collaborative [HPAC]. (2019). Guidance on developing quality interprofessional education for the health professions. Chicago, IL: Author. https://healthprofessionsaccreditors.org/wp-content/uploads/2019/02/HPACGuidance02-01-19.pdf
Health Resources Services Administration. (n.d.). Geriatrics. Retrieved from https://bhw.hrsa.gov/grants/geriatrics
Holmes, H. M., Hayley, D. C., Alexander, G. C., & Sachs, G. A. (2006). Reconsidering medication appropriateness for patients late in life. Archives of Internal Medicine, 166(6), 605-609. https://doi.org/10.1001/archinte.166.6.605
Inouye, S. K., Bogardus, S. T., Charpentier, P. A., Leo-Summers, L., Acampora, D., Holford, T. R., & Cooney, L. M. (1999). A multicomponent intervention to prevent delirium in hospitalized older patients. New England Journal of Medicine, 340(9), 669-676. https://doi.org/10.1056/nejm199903043400901
Institute of Medicine [IOM]. (2008). Retooling for an aging America: Building the health care workforce. The National Academies Press. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK215401/
IOM. (2015). Measuring the impact of interprofessional education on collaborative practice and patient outcomes. The National Academies Press. Retrieved from https://www.nap.edu/read/21726/chapter/1
Interprofessional Education Collaborative. (2016). Core competencies for interprofessional collaborative practice: 2016 update. Author. Retrieved from https://hsc.unm.edu/ipe/resources/ipec-2016-core-competencies.pdf
Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Author. https://www.uthsc.edu/simulation/documents/ipec-report.pdf
Isaacs/Jellinek. (2019, January). Assessment of the accomplishments and impact of the John A. Hartford Foundation’s grantmaking in aging and health, 1983-2015. New York, NY: The John A. Hartford Foundation. Retrieved from https://www.johnahartford.org/images/uploads/reports/JAHF_Accomplishments_Impact_Report_FINAL_1.7.2019.pdf
Kempen, F., Yardley, L, van Haastregt, J., Zijlstra, G., Beyer, N., Hauer, K., & Todd, C. (2008). The short FES-I: A shortened version of the Falls Efficacy Scale-international to assess fear of falling. Age and Ageing, 37(1), 45-50. https://doi.org/10.1093/ageing/afm157
Kloss, B. (2019, August 25). Anticholinergic toxidrome. Life in the FastLane. https://litfl.com/anticholinergic-toxidrome/
Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.) (2000). To err is human: Building a safer health system. Committee on Quality of Health Care in America, Institute of Medicine. National Academies Press. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK225182/
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x Kruger, J., & Dunning, D. (1999). Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessments. Journal of Personality and Social Psychology, 77(6), 1121-1134. https://doi.org/10.1037/0022-3514.77.6.1121
Kua, C., Mak, V. S. L., & Lee, S. W. H. (2019). Health outcomes of deprescribing interventions among older residents in nursing homes: A systematic review and meta-analysis. Journal of Post-Acute and Long-Term Care Medicine, 20(3), 362-372. https://doi.org/10.1016/j.jamda.2018.10.026
Lairamore, C., Morris, D., Schichtl, R., George-Paschal, L., Martens, H., Maragakis, A., Garnica, M., Jones, B., Grantham, M., & Bruenger, A. (2018). Impact of team composition on student perceptions of interprofessional teamwork: A 6-year cohort study. Journal of Interprofessional Care, 32(2), 143-150. https://doi.org/10.1080/13561820.2017.1366895
MacDonald, C. J., Archibald, D., Trumpower, D. L., Casimiro, L., Cragg, B., & Jelley, W. (2010). Designing and operationalizing a toolkit of bilingual interprofessional education assessment instruments. Journal of Research in Interprofessional Practice and Education, 1(3), 304-316. https://doi.org/10.22230/jripe.2010v1n3a36
Maguire, L. (1991). Social Support systems in practice: A generalist approach. NASW Press.
Mini-Cog©. (n.d.). Mini-Cog©: Screening for cognitive impairment in older adults. https://mini-cog.com/
Morley J. E., Vellas, B., van Kan G. A., Anker, S. D., Bauer, J. M., Bernabei, R., Cesari, M., Chumlea, W. C., Doehner, W., Evans, J., Fried, L. P., Guralnik, J. M., Katz, P. R., Malmstrom, T. K., McCarter, R. J., Gutierrez Robledo, L. M., Rockwood, K., von Haehling, S., Vandewoude, M. F., & Walston, J. (2013). Frailty consensus: A call to action. Journal of the American Medical Directors Association, 14(6), 392-397. https://doi.org/10.1016/j.jamda.2013.03.022
National Center for Health Statistics. (2017). Health, United States. In Health, United States, 2016: With chartbook on long-term trends in health. https://www.cdc.gov/nchs/data/hus/hus16.pdf
Pruskowski, J., Sakely, H., & Handler, S. (2019). Development of a required longitudinal residency experience focused on deprescribing. American Journal of Health-System Pharmacy, 76(4), 236-241. https://doi.org/10.1093/ajhp/zxy029
Quach, L., Galica, A. M., Jones, R. N., Procter-Gray, E., Manor, B., Hannan, M. T., & Lipsitz, L. A. (2011). The non-linear relationship between gait speed and falls: The MOBILIZE Boston Study. Journal of the American Geriatrics Society, 59(6), 1069-1073. https://doi.org/10.1111/j.1532-5415.2011.03408.x
Reeves, S., Palagana, J., & Zierler, B. (2015). Appendix B: Synthesis of interprofessional education reviews. In Institute of Medicine (Ed.), Measuring the impact of interprofessional education on collaborative practice and patient outcomes, (pp. 135-145). The National Academies Press. https://doi.org/10.17226/21726
Rockwood, K., Song, X., MacKnight, C., Berman, H., Hogan, D. B., McDowell, I., & Mitnitski, A. (2005). A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal, 173(5), 489-495. https://doi.org/10.1503/cmaj.050051
Roumell, E. A. (2019). Priming adult learners for learning transfer: Beyond content and delivery. Adult Learning, 30(1), 15-22. https://doi.org/10.1177/1045159518791281
Safety Net Medical Home. (n.d.). Oral health: An essential component of primary care. http://www.safetynetmedicalhome.org/sites/default/files/Oral-Health-Screening-Questions.pdf
Salas, E., DiazGranados D, Klein, C., Burke, C. S., Stagl, K. C., Goodwin, G. F., & Halpin, S. M. (2008). Does team training improve team performance? A meta-analysis. Human Factors. 50(6), 903-933. https://doi.org/10.1518/001872008x375009
Salas, E., Weaver, S. J., DiazGranados, D., Lyons, R., & King, H. (2009). Sounding the call for team training in health care: some insights and warnings. Academic Medicine, 84(10), S128-S131. https://doi.org/10.1097/acm.0b013e3181b37d48
Schmitz, C. C., Radosevich, D. M, Jardine, P., MacDonald, C. J., Trumpower, D., & Archibald, D. (2017). The interprofessional collaborative competency attainment survey (ICCAS): A replication validation study. Journal of Interprofessional Care, 31(1), 28–34. https://doi.org/10.1080/13561820.2016.1233096
Scott, I. A., Hilmer, S. N., Reeve, E., Potter, K., Le Couteur, D., Rigby, D., Gnjidic, D., Del Mar, C. B., Roughead, E. E., Page, A., Jansen, J., & Martin, J. H. (2015). Reducing inappropriate polypharmacy: The process of deprescribing. JAMA Internal Medicine, 175(5), 827-834. https://doi.org/10.1001/jamainternmed.2015.0324
Shear, M. K., Simon, N., Wall, M., Zisook, S., Neimeyer, R., Duan, N., Reynolds, C., Lebowitz, B., Sung, S., Ghesquiere, A., Gorscak, B., Clayton, P., Ito, M., Nakajima, S., Konishi, T., Melhem, N., Meert, K., Schiff, M., O’Connor, M., … Keshaviah, A. (2011). Complicated grief and related bereavement issues for DSM-5. Depression & Anxiety, 28(2), 103-117. https://doi.org/10.1002/da.20780
Sheikh, J. I., & Yesavage, J. A. (1986). Geriatric depression scale (GDS): Recent evidence and development of a shorter version. Clinical Gerontologist, 5(1-2), 165-173. https://doi.org/10.1300/j018v05n01_09
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092-1097. https://doi.org/10.1001/archinte.166.10.1092
U.S. Centers for Disease Control and Prevention. (2010). Number, percent distribution, rate, days of care with average length of stay, and standard error of discharges from short‐stay hospitals, by sex and age: United States, 2010. Atlanta, GA: Author. https://www.cdc.gov/nchs/data/nhds/2average/2010ave2_ratesexage.pdf
Weinstein, B. E., & Ventry, I. (1983). Audiologic correlates of hearing handicap in the elderly. Journal of Speech, Language, and Hearing Research, 26(1), 148-151. https://doi.org/10.1044/jshr.2601.148 Vespa, J., Armstrong, D. M., & Medina, L. (2018, March). Demographic turning points for the United States: Population projections for 2020 to 2060. Suitland, MD: U.S. Census Bureau. https://permanent.access.gpo.gov/gpo93743/P25_1144.pdf
Violato, E. M., & King, S. (2019). A validity study of interprofessional collaborative competency attainment survey: An interprofessional collaborative competency measure. Journal of Nursing Education, 58(8), 454-462. https://doi.org/10.3928/01484834-20190719-04
Thompson, W., Reeve, R., Moriarty, F., Maclure, M., Turner, J., Steinman, M. A., Conklin, J., Dolovich, L. McCarthy, L., & Farrell, B. (2019). Deprescribing: Future directions for research. Research in Social and Administrative Pharmacy, 15(6), 801-805. https://doi.org/10.1016/j.sapharm.2018.08.013
Weiner, D. K., Marcum, Z., & Rodriguez, E. (2016). Deconstructing chronic low back pain in older adults: Summary recommendations. Pain Medicine, 17(12), 2238-2246. https://doi.org/10.1093/pm/pnw267
Wharton, T., & Burg, M. A. (2017). A mixed-methods evaluation of social work learning outcomes in interprofessional training with medicine and pharmacy students. Journal of Social Work Education, 53(sup1), S87-S96. https://doi.org/10.1080/10437797.2017.1288592
White, J. V., Guenter, P., Jensen, G., Malone, A., & Schofield, M. (2012). Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition. Journal of Parenteral and Enteral Nutrition, 36(3), 275-283. https://doi.org/10.1177/0148607112440285
World Health Organization. (2010). Framework for action on interprofessional education & collaborative practice. Author. https://apps.who.int/iris/bitstream/handle/10665/70185/WHO_HRH_HPN_10.3_eng.pdf?sequence=1
Author note: Address correspondence to Elizabeth Mulvaney, School of Social Work, University of Pittsburgh, 2117 Cathedral of Learning, Pittsburgh, PA 15260. Email: eam65@pitt.edu
