Learning Together: Interprofessional Education at the University of New England

The Center for Excellence in Collaborative Education, University of New England's (UNE) interprofessional education (IPE) hub, brings students together from osteopathic medicine, dentistry, pharmacy, nursing, physical therapy, occupational therapy, social work, physician assistant, nurse anesthesia, public health, dental hygiene, exercise science, and athletic training. UNE's focus on health includes cross-professional exchange and cultural and biodiverse perspectives.

Patient care delivered by well-functioning teams that provide integrated and cohesive responses for patients, families, and populations is more effective than care delivered by independent health care professionals.¹ Adverse consequences of poorly functioning teams include medical errors and inefficient, unsatisfactory, and diminished quality of patient care, which drives up costs.² Team-based competencies and IPE are essential to health professions education,³ and colleges of osteopathic medicine should capitalize on opportunities for collaborative learning with their colleagues in other health professions.⁴

Learning outcomes, competencies, and accreditation standards across health profession programs mandate that curricula include “knowledge and skills in teamwork, communication, health information systems, quality and process improvement, social determinants of health, and population health.”⁵ Residencies and employers increasingly seek students graduating from programs that emphasize such skills.⁶

Despite IPE's growing support, debate continues about when and how much to expose students to interprofessional competencies and collaborative practice methods in their preclinical and clinical curricula. Historically, students learned teamwork skills and about the roles and responsibilities of other health professions through naturally occurring interactions in the clinic. Although applied knowledge in clinical settings can cement interprofessional learning, cross-professional interactions that are not intentionally designed may be haphazard in the clinical curriculum. These interactions may not occur in some settings, may not include beneficial debriefing conversations and reflection, and may be influenced by biases, assumptions, and power dynamics that detract from learning about patient-centered care and team efficiency. Explicit preclinical exposure to and integration of interprofessional competencies and practices in health profession education is advised to prepare students for clinical education and workplace success.

Evolution of IPE at UNE

UNE's commitment to IPE began in 2000. The establishment of the IPE Collaborative (IPEC) in 2010 solidified its stake in IPE academic, clinical, and community-based practice education. UNE IPEC provides leadership for and facilitation of a continuum of evidence-based and theoretically informed collaborative programming across UNE and in clinical and community settings. Its mission aims to prepare future health professionals with contextual knowledge, intercultural proficiency, cultural humility, and readiness to participate as members and leaders of interprofessional clinical and community health and social care teams. UNE's cross-professional collegial and collaborative culture benefits faculty. Students observe and experience teamwork in the implicit curriculum, which they can then translate into their roles as health care and service providers and organizational leaders.

Competencies and Common Learning Outcomes

Collaborative learning curriculum and activities at UNE are guided by an integration of competencies and behaviors outlined in the Core Competencies for Interprofessional Collaborative Practice Reports issued by the US IPE Expert Panel,^1,4 the Canadian Interprofessional Collaborative Framework,⁷ and the World Health Organization Framework for Action on IPE and Collaborative Practice,⁸ which states

(i)nterprofessional collaborative practice happens when multiple health workers from different professional backgrounds work together with patients, families, caregivers and communities to deliver the highest quality of care. It allows health workers to engage any individual whose skills can help achieve local health goals.

This definition served as a guidepost for the development of curricula and desired learning outcomes for UNE students across the learning continuum.

At UNE, the integration of US and Canadian interprofessional competencies with critical concepts of community, cultural, and public/population health strengthen IPE learning opportunities, readying students for real-world situations that they will encounter in clinical rotations and future practice. Students entering UNE are introduced to IPE competencies and case-based learning methods at orientation. IPE activities are scaffolded, meaning that students are longitudinally exposed to and participate in IPE activities through a developmental continuum of learning activities, including simulation- and community-based immersive activities. This article assesses the implementation of interprofessional competencies and learning outcomes using the Interprofessional Team Immersion (IPTI) at UNE.

Methods

This survey-based study used a nonexperimental design with a sample of students from 8 different health profession programs at UNE, including the UNE College of Osteopathic Medicine (UNECOM). Students completed a 4-session IPTI learning activity in 2018 and both pre- and postsurveys. The institutional review board at UNE reviewed this project on January 8th, 2016, and granted exemption status.

Study population

Students from 8 UNE programs participated in a 4-session IPTI (Figure 1). Students were divided into 8 teams of 8 students with a representative from each program on each team. Student teams were assigned at least 2 faculty members to facilitate but not lead discussions.

Figure 1.

Timeline of Interprofessional Team Immersion (IPTI) at the University of New England. Fifty-five students participated in the IPTI examined in this study. Abbreviation: IPE, interprofessional education.

Results

Fifty-five students participated in the IPTI examined in this study. Pre- and postsurveys were completed and successfully paired for 43 students for a response rate of 78%. Response rates among specific professions ranged from a low of 50% for dental hygiene students to a high of 100% for nursing students (Table 1). Thirty-three respondents were women (77%) and 10 were men (23%). Twenty respondents were third-year students (46%), 12 were second-year students (28%), and 11 were first-year students (26%). Surveys were excluded on a case-by-case analysis. Three students skipped ICCAS items on pre- or postsurveys, and 1 student skipped an ISVS item on a presurvey.

The individual item and total ICCAS scores (n=40) revealed nonnormal distribution (skewed negative or left and positive kurtosis) of most individual scale items, subscale scores, and total scores (even with extreme outliers removed from analysis). Therefore, nonparametric methods were used to analyze changes from pre- to postsurveys in subscales and total scores. The results in Table 2 indicate that ICCAS total scores increased from a mean of 121 in the presurvey to 128 in the postsurvey. Related-samples Wilcoxon signed rank results indicated a statistically significant increase (P=.018). Table 2 shows that ISVS total scores (n=42) increased from a presurvey mean of 48.3 to a postsurvey mean of 57.9. Paired t test results indicated that this change was statistically significant (P<.0001). Qualitative results showed that UNECOM students found the IPTI experience to be beneficial (Figure 2).¹⁴

Figure 2.

Overview and comments from University of New England students regarding the Interprofessional Team Immersion (IPTI) and interprofessional education (IPE) benefits from their IPE experiences.¹⁴Abbreviation: DO, doctor of osteopathic medicine.

Discussion

During the past decade, different models for introducing students to interprofessional learning and collaborative practice have been piloted and tested by UNE IPEC; some were discarded while others thrived. Since 2015, UNECOM has worked to ensure that students engage and actively integrate into UNE's IPE activities. IPTI has had continuous and scalable success. Grounded in CBL, IPTI provides experiential and didactic opportunities for both process and product learning outcomes commensurate with evidence-based and interprofessional theory tenets^15-17 and collaborative competencies.^1,4,7,8

Findings from the current study suggested that students improved their abilities to communicate with students from other professions and better understood each other's respective roles and responsibilities. The survey findings showed statistically significant effects on students’ self-reported interprofessional knowledge, attitude, and skills from participation in IPTI. Students seemed appreciative of learning about the depth and scope of other disciplines and how their roles sometimes overlapped. Navigating leadership responsibilities was an area of observed challenge; however, students gained respect for the collaborative enterprise because it served the greater needs of the patient.

Increasing IPE programming to ensure that all students have opportunities to be exposed to and demonstrate collaborative competencies in preclinical and clinical settings remains a challenge. Currently, some UNE programs build IPE into their curricula; others require attendance at certain activities or provide students with a menu of IPE options to earn an interprofessional honors distinction. IPE developers look to find novel curricular methods to embed IPE into existing UNECOM curricula, for example, in shared, asynchronous CBL. A further obstacle is ensuring that all faculty are trained in interprofessional competencies and facilitation skills. Students take the lead from their respective faculty and model their views and actions. Thus, the teaching process is as important, if not more so, than the content and must align with IPE project aims. A considerable challenge still faced is sufficient allotment of faculty time and resources to develop and execute IPE learning activities.

An unintended, yet highly beneficial consequence of IPTI and IPEC at UNE is the camaraderie that has developed among the faculty across programs. These relationships have contributed to inventive programming; for example, asynchronous IPE learning whereby UNECOM and other health professions students share a case and are required by assignment to learn from each other. Mutual investment in IPE has helped build a robust core collective of faculty, professional staff, students, and administrators who work together to implement and prioritize appropriate training and engagement in IPE initiatives.

The limitations of this study included that the competency assessments relied on students’ self-report, and the study lacked a control or comparison group. Additionally, this study focused on only 1 college of osteopathic medicine and short-term outcomes. Future research could include additional IPE programs and measure the effect 6 to 12 months after the experience.

Conclusion

Deliberate curricular and cocurricular infusion of interprofessional interactions in the preclinical years provides osteopathic medical students and their peers from other health profession programs with essential tools to understand and practice in today's complex health care environment. Experiences such as IPTI offer students opportunities to learn about the intricacies of interprofessional health care teams and teach teamwork skills for clinical rotations. We have shown that IPTI has changed students’ perceptions of IPE and expanded their knowledge of other health care professionals’ roles and responsibilities. We propose the integration of interprofessional, interdisciplinary, and collaborative learning across program curricula.

Author Contributions

All authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; all authors drafted the article or revised it critically for important intellectual content; all authors gave final approval of the version of the article to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved