A team-based learning approach to interprofessional education of medical and pharmacy students

Impact of Just-in-Time TeamSTEPPS Training on Team Performance in a Pediatric Escape Room Interprofessional Experience

OBJECTIVE

To compare differences in observed and self-reported team dynamics between those who received versus those who did not receive TeamSTEPPS training prior to an interprofessional escape room scenario.

METHODS

Final-year pharmacy (N = 27) and physician assistant (N = 88) students participated in an escape room featuring pediatric dosing, asthma, otitis media, type 1 diabetes, and vaccine fundamentals. In total, 29 teams were randomized to control (14) or intervention arm (15). The control group went to the escape room and then returned to the classroom for a team-building module including TeamSTEPPS training. The intervention group started with the team-building module then went to the escape room. One faculty observer was assigned to each team and utilized the Performance Assessment Communication and Teamwork (PACT) expert-observer form to assess team performance. Post-event, students completed an abbreviated PACT post-assessment and a self-reflection on the prompt "What were the most important takeaways from today's interprofessional education experience?"

RESULTS

On the PACT expert-observer form, significantly higher global scores were noted for the intervention arm on all items except situation monitoring. On the aggregate observer data from all stations, leadership emerged as statistically different between the 2 groups. On the PACT post-assessment, the intervention arm reported significantly more leadership during the simulation. On the self-reflections, 70.9% versus 64% in the control arm recognized the importance of teamwork in managing patients.

CONCLUSIONS

Just-in-time TeamSTEPPS training improved observed and to a lesser extent, self-reported teamwork and communication skills. Incorporating TeamSTEPPS training immediately prior to an interprofessional education experience may enhance team performance.

[Evaluation of simulation-based training program intended to improve interprofessional communication skills of community pharmacy and general medicine students]

OBJECTIVES

The objective of this work is to assess the impact of a simulation session on the ability of pharmacy and medicine students in general practice to communicate in the resolution of patient-facing situations.

METHODS

The evaluation of the impact of the session on the representation of the professions used a questionnaire to be completed before and after the session by the students. The evaluation of the impact of the session on the perception of communication and associated skills was based on an audio recording of the debriefings, which, after transcription and thematic analysis, was used as a preliminary analysis for the drafting of a questionnaire proposed the following year. This questionnaire focused on the issues of interprofessional communication and on the seminar process.

RESULTS

During the 2018 and 2019 seminars, 518 students attended, 39% were pharmacy students (n=201) and 61% were medical students (n=317). The majority of medical students initially responded that physician-pharmacist communication was confraternal and rare. More pharmacy students felt that the quality of the physician-pharmacist relationship was poor. However, there was a marked improvement for all students on this aspect of communication after the seminar. Both groups also generally agreed that this relationship could be improved.

CONCLUSIONS

The evaluation shows that an interprofessional simulation program improves the ability of pharmacy and general practice students to communicate in patient-facing situations.

Education without walls: Using a street medicine program to provide real-world interprofessional learning

Interprofessional education (IPE) is a core component of the curricula for many healthcare and social work training programs and has been shown to increase student self-efficacy, communication skills, and attitudes toward other professions. Street medicine programs expand options for teaching interprofessional, team-based care of vulnerable populations, such as those experiencing homelessness. Street Medicine Phoenix is an interprofessional team of health professions students and faculty that provides outreach to Phoenix's homeless population. This study demonstrates the impact of volunteering in our street medicine program on the perceived development of interprofessional skills and behaviors. Volunteer teams, with representatives from medicine, nursing, social work, physical therapy, occupational therapy, public health, and undergraduate studies, completed the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) before and after semester-long, monthly outreach events. Results demonstrate statistically significant improvements in overall ICCAS scores for all volunteers, but there was no relationship between number of shifts completed and ICCAS score improvement. Based on these findings, street medicine programs could be considered as an option for providing interprofessional learning to students in healthcare and social work degree programs. Street medicine outreach can supplement didactic and simulation skill-building activities in the IPE curricula with point of care, real-world experiential learning.

Successful Development and Implementation of a Large Virtual Interprofessional Education Activity Applying the Social Determinants of Health

Interprofessional education (IPE) activities provide students insight into healthcare teams, shared decision-making, and social determinants of health (SDOH). Virtual IPE activities with large student populations or across multicampus have not been evaluated. The study aimed to explore the interprofessional competency growth in students, across several disciplines, following participation in a large-scale, virtual IPE activity. Students from pharmacy, medicine, social work, and physician assistant programs across Tennessee participated in an IPE patient case and SDOH in fall 2020 and fall 2021. Pre- and postsurveys included Likert ranking of 16 statements based on the 2011 Interprofessional Education Collaborative (IPEC) framework. A total of 607 students completed surveys (overall response rate, 76%). Wilcoxon signed-rank tests were performed on the pre-/postsurvey data, in aggregate and by discipline. Significant increases in all IPEC competency statements were seen, both in aggregate (100% of statements with p < 0.001) and in pharmacy (100% of statements with p < 0.001) and medicine subgroups (94% of statements with p < 0.001). Implementing large virtual IPE activities involving a complex patient case and SDOH significantly increased student IPEC competency outcomes for participating students, whether in aggregate or on a discipline-specific basis.

The Effectiveness of Flipped Classroom during the COVID-19 Pandemic in Higher Pharmaceutical Education

BACKGROUND: Despite the apparent advantages of the flipped classroom model especially during a pandemic or natural or technogenic disasters, its overall effectiveness in higher medical and pharmaceutical education continues to be debated. AIM: The goal of the study was to test the effectiveness and acceptability of using the flipped classroom model during the COVID-19 pandemic in higher pharmaceutical education based on the example of the “Pharmaceutical Marketing” discipline at Sechenov First Moscow State Medical University, Russia. METHODS: The study involved 156 fourth-year pharmacy students. They were divided into three clusters: FC – studying in accordance with the flipped classroom model, FC+TBL – using the flipped classroom technology combined with the team-based method, and CC – studying by the traditional scheme (control). The study used the Unified educational portal of the Sechenov University. Additional elements were developed for the electronic educational and methodical complex for the studied section “Analysis of the marketing environment of a pharmaceutical organization.” The effectiveness of the flipped classroom model was evaluated through test control (entrance, formative, thematic, and final) and control of the development of skills and abilities in solving situational problems (thematic and final). The study participants’ attitude toward the use of the flipped classroom model was assessed through a survey. RESULTS: The study demonstrated that students from the FC and FC+TBL clusters were significantly better prepared for practical lessons and worked more effectively and productively during these classes compared to the CC cluster students. The results of the final control also substantiate the advantages of the flipped classroom technology both in assessing practical skills and abilities and in testing. The opportunities for rational implementation of the complex technology (FC+TBL cluster) are identified. CONCLUSIONS: The analysis of students’ general opinion on the flipped classroom model shows that 90.4% of the FC cluster members and 84.6% of the FC+TBL cluster members are satisfied with the results of using this model and consider it suitable for studying both the “Analysis of the marketing environment of a pharmaceutical organization” section and the entire pharmaceutical marketing course. Students’ positive feedback on the use of the flipped classroom model provides grounds for further implementation of this technology in the “Pharmaceutical Marketing” discipline in its entirety and demonstrates that further research on the use of other blended learning models is quite promising.

Interprofessional Team-Based Learning: A Qualitative Study on the Experiences of Nursing and Physiotherapy Students

Traditional discipline-specific training has limitations in facilitating inter-professional communication and collaboration. To address this issue, two local universities in Hong Kong launched an interprofessional team-based learning program to allow the undergraduate healthcare students to form teams and experience collaborative problem-solving. This study aimed to evaluate the experiences of nursing and physiotherapy undergraduates following interprofessional learning activities. Twenty-seven 3rd-year nursing and physiotherapy undergraduates were recruited through purposive sampling. Semi-structured interviews were conducted, and written feedback was solicited until data saturation was achieved. An inductive thematic analysis was used for the data, and each theme was mutually exclusive. The findings revealed the positive experiences of the students with this interprofessional learning activity. Three main themes emerged: (1) the process of interprofessional learning; (2) profession-related outcomes of interprofessional learning; and (3) patient-related outcomes of interprofessional learning. The study indicated that interprofessional team-based learning activities enhanced learning experiences of the students through interactive learning with other healthcare students. Experiences of relationships that are trustful and complementary allow students to develop confidence in knowledge transfer and in interprofessional collaboration, as well as in providing a holistic patient-centered care. These findings substantiate the importance and value of interprofessional learning in healthcare education.

Competency Achievement of Apothecary Students through Community Health Interprofessional Program

Objective: aims to measure the achievement of inter-professional competency of apothecary and medical students after taking IPE in a form of home care visit. Methods: Fifty-eight students of pharmacy and seventy-eight medical students are listed in the community health interprofessional program (COHIP) by simulation on prescription service and followed by home visit to patients of public health center. Evaluation is conducted by taking the design of pre-test and post-test quasi-experimental without group control. The research result is measured by using Interprofessional Collaborative Competency Attainment Scale (ICCAS) consists of communication, collaborative, roles and responsibilities, collaborative patient/family-centered approach, conflict management/resolution, and team functioning. The compiled data are displayed descriptively in which statistical paired sample T-test was conducted. Result: 134 respondents involved in this program had finished the pre-test and post-test. The highest mean values of IPE activity of apothecary and medical student are collaborative and conflict management/resolution domain. The overall statistical analysis result of ICCAS domains and items shows significant improvement. Conclusion: Home visit program and simulation on prescription service in a frame of community health interprofessional program have effect towards the improvement of inter-professional competency of pharmacy and medical students, which consists of Communication, Collaborative, Roles and Responsibilities, Collaborative Patient/Family-Centered Approach, Conflict Management/Resolution, and Team Functioning.

Use of Established Guidelines When Reporting on Interprofessional Team-Based Learning in Health Professions Student Education: A Systematic Review

PURPOSE

Team-based learning (TBL) has gained popularity across the health professions, including in interprofessional contexts. The authors conducted this systematic review to summarize the published evidence regarding the extent, design, and practice of interprofessional TBL within health professions (including medical) degree programs to inform interprofessional education (IPE) educators and curricula designers.

METHOD

In June 2020, the authors searched PubMed Central, CINAHL, Web of Science, and ERIC for original research articles describing TBL programs with student representation from multiple health professions degree programs that were published between January 2010 and June 2020. Included articles underwent data extraction for study characteristics (e.g., country of origin, topics covered, class descriptors) and the 7 core design elements of TBL: team formation, readiness assurance, immediate feedback, sequencing of in-class problem solving, the 4 Ss (significant problem, same problem, specific choice, and simultaneous reporting), incentive structure, and peer review.

RESULTS

Twelve articles were included. Significant variability was noted in the application and reporting of the 7 core design elements of TBL, which highlighted challenges to the implementation of interprofessional TBL.

CONCLUSIONS

Although the structured format of TBL provides a suitable pedagogy for IPE, this review identified challenges associated with the effective integration of IPE into TBL, including: the unequal distribution of students to teams as a result of there being multiple disciplines from different programs; varied levels of student experience with the pedagogy of TBL; a lack of resources required for large groups of students; timetabling requirements for multiple disciplines from different programs; inability to provide more than 1 TBL session; design of patient cases that suit multiple disciplines; alignment of topics within the curricula of multiple disciplines, programs, and universities; inequities in grading for different students within the same TBL program; and limited opportunity for peer review.

Preparing a healthcare workforce for geriatrics care: an Interprofessional team based learning program

Background

Improving the care of older adults in our healthcare system involves teams working together. As the geriatrics population rises globally, health science learners need to be prepared to work collaboratively to recognize and treat common conditions in geriatrics. To enable workforce preparation, the Institute of Medicine and the National League for Nursing emphasize the need to implement interprofessional active learning activities for undergraduate healthcare learners at academic medical centers.

Methods

The Geriatrics Champions Program was a team-based learning activity created to meet this task. It was a 24-month program, repeated twice, that impacted 768 learners and 151 faculty from medicine, occupational therapy, physical therapy, nursing, social welfare, psychology, pharmacy and dietetics. Each class was intentionally divided into 20 interprofessional teams that met four times annually. Each session focused on one geriatrics domain. The objectives were centered around the specific geriatrics competencies for each health profession, divided into the eight domains written in the “American Geriatrics Society IM-FM Residency Competencies”. Evaluation consisted of individual and team Readiness Assessment Tests (iRAT and tRAT). Surveys were also used to collect feedback using a Likert scale. Wilcoxon signed rank tests were used to compare iRAT and tRAT scores. Other analyses identified characteristics associated with tRAT performance group (Unpaired t-tests) and tRAT performance on the raw scale (Pearson correlation). Paired t-tests using a 7-level Likert Scale measured pre-post change in learner knowledge.

Results

Student tRAT scores were 30% higher than iRAT scores (p < 0.001). Teams were more likely to score 100% on the initial tRAT attempt if more team members attended the current session (p < 0.001), more health professions were represented by team members in attendance (p = 0.053), and the team had a better track record of past attendance (p < 0.01). In the post-program evaluation, learners felt this program was helpful for their career preparation in interprofessional geriatrics care.

Conclusions

Learners understood that teams performed better than individuals in the care of older adults. Feedback from the learners and faculty was consistently positive and learners felt better prepared for geriatrics care. The program’s benefits may extend beyond individual sessions.

TESOT: a teaching modality targeting the learning obstacles in global medical education

In higher education, it is a great challenge for instructors to teach international medical students (IMSs) efficiently. These students usually have different learning obstacles and learning style preferences from domestic students. Thus it is necessary to use teaching modalities targeting the specific characteristics of IMSs. Accordingly, we have developed a teaching modality composed of classical teacher-centered approach (TCA), enriched with components of student-centered approach (SCA) and online interactions targeting the learning characteristics of IMSs, which we defined as TESOT (an acronym made of the underlined words' initials). Aside from the online interactions that provide both answers to questions raised by students and guidance throughout a course, this modality contains additional in-classroom components (i.e., pre-lecture quiz, student-led summary, and post-lecture quiz). The effectiveness of this modality was tested in the nervous system module of the Physiology course for IMSs. The final exam scores in the nervous system module in the year taught with TESOT were higher than those earned by students taught with a classical TCA modality in preceding 2 yr. The improvement of teaching effectiveness is attributable to increasing communication, bridging course contexts, and meeting diverse learning style preferences. These results indicate that TESOT as an effective teaching modality is useful for enhancing efficiency of teaching IMSs.

Optimising student-led interprofessional learning across eleven health disciplines

BACKGROUND

Provision of effective Interprofessional learning (IPL) opportunities plays a vital role in preparing healthcare students for future collaborative practice. There is an identified need for universities to better prepare students for interprofessional teamwork, however, few large-scale IPL activities have been reported. Additionally, little has been reported on disciplinary differences in student learning experience. The Health Collaboration Challenge (HCC) is a large-scale IPL activity held annually at the University of Sydney. This study sought to explore students' experience of early participation in an interprofessional case-based learning activity, and the similarities and differences in the perceived value of interprofessional (social) learning for each discipline.

METHODS

In 2018, 1674 students from 11 disciplines (dentistry, oral health, nursing, pharmacy, medicine, occupational therapy, speech pathology, physiotherapy, dietetics, diagnostic radiography, exercise physiology) participated in the HCC. Students worked in teams to produce a video and patient management plan based on a patient case. Participants completed a questionnaire, including closed and open-ended items. Quantitative data were analysed using descriptive statistics. Thematic analysis was used to code and categorise qualitative data into themes. These themes were then applied and quantified at a disciplinary level to measure prevalence.

RESULTS

In total, 584/1674 (35%) of participants responded to the questionnaire. Overall, students perceived their experience to be largely beneficial to their learning and interprofessional skill development. Positive aspects included opportunities for peer learning, collaboration, networking, and understanding the different roles and responsibilities of other health professions. Negative aspects included the video form of assessment, inequity in assessment weighting across disciplines, the discipline mix within teams and lack of case relevance.

CONCLUSION

The learning activity provided a framework for students to practice and develop their skills in interprofessional teamwork, as they prepare for increased clinical placements. Overall, students perceived their experience as beneficial to their learning and professional development early in their degree. However, they expressed dissatisfaction with the inequity of assessment weighting across the disciplines; lack of relevance of the case across disciplines; and the activity of producing a video. Further research is needed regarding the ideal number of disciplines to include in teamwork specific to a patient case.

Interprofessional Team-based Learning: Building Social Capital

Often the first-time health professionals work together is as new graduates, with a paucity of shared learning among the various health disciplines within university curricula. This is largely due to the complexities of delivering interprofessional education (IPE) and the preference of individuals to work within their established silos. With its ability to nurture collaboration among students, there is a developing trend to use team-based learning (TBL) as a teaching method to engage health care students in IPE. Using the conceptual lens of social capital theory, the purpose of this article is to provide readers with an overview and evidence for the use of TBL within the interprofessional health care education setting, highlighting the benefits and challenges.