Training family medicine residents to practice collaboratively with psychology trainees

Exploring experiential learning within interprofessional practice education initiatives for pre-licensure healthcare students: a scoping review

BACKGROUND

Interprofessional collaborative team-based approaches to care in health service delivery has been identified as important to health care reform around the world. Many academic institutions have integrated interprofessional education (IPE) into curricula for pre-licensure students in healthcare disciplines, but few provide formal initiatives for interprofessional practice (IPP). It is recognized that experiential learning (EL) can play a significant role supporting IPP education initiatives; however, little is known of how EL is used within education for IPP in healthcare settings.

METHODS

We conducted a scoping review to map peer-reviewed literature describing IPP education initiatives involving EL for pre-licensure students in healthcare disciplines. A literature search was executed in MEDLINE, CINAHL, EMBASE, ERIC, PsycINFO, Scopus, and Social Services Abstracts. After deduplication, two independent reviewers screened titles and abstracts of 5664 records and then 252 full-text articles that yielded 100 articles for data extraction. Data was extracted using an Excel template, and results synthesized for presentation in narrative and tabular formats.

RESULTS

The 100 included articles represented 12 countries and IPP education initiatives were described in three main typologies of literature - primary research, program descriptions, and program evaluations. Forty-three articles used a theory, framework, or model for design of their initiatives with only eight specific to EL. A variety of teaching and learning strategies were employed, such as small interprofessional groups of students, team huddles, direct provision of care, and reflective activities, but few initiatives utilized a full EL cycle. A range of perspectives and outcomes were evaluated such as student learning outcomes, including competencies associated with IPP, impacts and perceptions of the IPP initiatives, and others such as client satisfaction.

CONCLUSION

Few educational frameworks specific to EL have been used to inform EL teaching and learning strategies to consolidate IPE learning and prepare students for IPP in healthcare settings. Further development and evaluation of existing EL frameworks and models would be beneficial in supporting robust IPP educational initiatives for students in healthcare disciplines. Intentional, thoughtful, and comprehensive use of EL informed by theory can contribute important advances in IPP educational approaches and the preparation of a future health care workforce.

Prevalence and predictors of team-based care activities between primary care providers and embedded behavioral health providers: a national survey

Primary care (PC) settings increasingly use team-based care activities with embedded behavioral health providers (BHPs) to enhance patient care via group medical visits, conjoint appointments, team huddles, and warm handoffs. Aim 1 was to describe the variation of team-based care activities within integrated PC clinics. Aim 2 was to explore whether factors associated with the BHP (e.g., gender, training, and experience) and the PC setting (e.g., perceived teamwork) predict engagement in team-based activities. A national sample of eligible BHPs (n = 345; 14.2% response rate) completed an anonymous survey assessing the presence/intensity of team-based care activities. 90% of BHPs reported regularly engaging in team-based care activities with PC teams. Most engagement occurred when providing feedback to PC providers (90.4% at least daily) and during warm handoffs (90.4% at least once daily). Engagement in team-based care was predicted by the level of teamwork occurring within the PC clinic (βs = .41-.47; ps < .001) and BHP characteristics, such as the number of years spent in PC (βs = .24-.26, ps < .001). Although these data are promising, with many BHPs reportedly engaging in team-based activities with PC teams, there is significant variation. Researchers should continue to explore whether the engagement in these team-based care activities enhances patient care.

Physician Residents Shadowing a Certified WOC Nurse to Develop Interprofessional Competencies: A Quality Improvement Project

PURPOSE

The aim of this quality improvement (QI) project was to assess a shadowing experience with a certified WOC nurse (CWOCN) on 4 interprofessional collaborative practice domains: interprofessional communication, role awareness and responsibilities, teams and teamwork, and values and ethics for interprofessional practice.

PARTICIPANTS AND SETTING

Forty-nine physician residents in Family and Internal Medicine participated in this project set at a health system in Chicago, Illinois.

APPROACH

Residents spent 16 hours shadowing a CWOCN and completed the Interprofessional Education Collaborative Competency Self-Assessment Tool (IPESAT) pre- and postshadowing that measured 4 interprofessional education (IPE) domains: interprofessional communication, role awareness and responsibilities, teams and teamwork, and values and ethics for interprofessional practice. Paired t tests were performed to determine differences in IPESAT scores before and after the shadowing experience.

OUTCOMES

Residents demonstrated significant improvement in their overall knowledge of IPE (P = .000) as well as knowledge within each of the 4 domains (P = .000). After the shadowing experience, the overall ranking improved by 7.5%; the greatest gain (10.8%) occurred in the teamwork domain.

IMPLICATIONS FOR PRACTICE

We found that even a comparatively brief shadowing experience with a CWOCN improved knowledge in IPE competencies. The shadowing experience is now permanently part of the Internal Medicine Residency program, and based on these IPE outcomes, other residency programs in our setting, such as the Rehabilitation and Family Medicine program, have increased their requests to shadow with the CWOCN.

Training the Doctors: A Scoping Review of Interprofessional Education in Primary Care Behavioral Health (PCBH)

Primary care behavioral health (PCBH) is a model of integrated healthcare service delivery that has been well established in the field of psychology and continues to grow. PCBH has been associated with positive patient satisfaction and health outcomes, reduced healthcare expenditures, and improved population health. However, much of the education and training on PCBH has focused on developing behavioral health providers to practice in this medical setting. Less attention has been paid to physician team members to support and practice within an integrated environment. This is problematic as underdeveloped physician team members may contribute to low utilization and attrition of behavioral health consultants. A scoping review was conducted to examine the training of physicians in this domain since 2006. Twenty-one studies were identified, predominantly in Family Medicine training programs. Although PCBH training was generally well received, more program evaluation, formalized curriculum, and faculty development are needed to establish best practices.

An Interprofessional Residency Clinic Curriculum for Geriatrics and Palliative Care

BACKGROUND AND OBJECTIVES

Caring for geriatrics and palliative care patients requires integrated interprofessional care. Studies regarding interprofessional education in family medicine reveal concerns by residents regarding applicability in future practice. Our study objective was to determine the effectiveness of teaching multispecialty geriatric and palliative care skills to family medicine residents using an interprofessional clinic curriculum.

METHODS

We evaluated an interprofessional geriatric and palliative care outpatient curriculum from March 2014 to June 2015. The interprofessional team included pharmacists, psychologists, family medicine geriatricians, and palliative care providers. Family medicine residents in a 3-year residency program completed pre- and postassessments evaluating their confidence and knowledge in specific areas of geriatric and palliative care. These assessments covered their abilities in starting advance care planning and setting goals in care discussions, as well as fall and depression assessment and elderly medication review. The subsequent resident perception of teaching effectiveness was also assessed. Qualitative comments were evaluated for themes. Patient perceptions were also surveyed.

RESULTS

Family medicine residents completed 52 surveys (51%). Improvements in all areas were significant (P<0.05). Postevaluation mean scores by year and by session demonstrated significant improvements in palliative care tools and teaching effectiveness. Qualitative comments revealed three themes: overall positive or negative educational value and understanding of assessments, reflection on interprofessional collaboration and team experience value, and improvements in logistics and collaboration. Patient satisfaction surveys reported improved satisfaction with their PCMH.

CONCLUSIONS

The use of an interprofessional and multispecialty clinic curriculum to teach geriatric and palliative care improved resident self-assessed knowledge and confidence as well as teaching effectiveness. Further studies evaluating resident exposure to such visits could substantiate the long-term influence of this educational endeavor.

Behavioral Health Assessments and Interventions of Psychology Trainees and Residents During Dual Interviewing: Replication and Extension

The integration of psychologists and other behavioral health providers in primary care practice continues to evolve and reshape approaches to patient care. This study is a replication and extension of a 2013 study describing dual interviewing encounters involving psychology trainees and family medicine residents within an integrated primary care clinic as it relates to behavioral health assessments and interventions. Psychology trainees provided descriptions of 400 collaborative patient encounters involving 337 single and 63 repeat encounters. Psychology trainees coded the frequency of behavioral health assessments and interventions by the psychology trainee, family medicine resident, or both. Seventy-eight percent of encounters contained an assessment, and 20% contained interventions. Compared to the 2013 study, there were significantly fewer behavioral health interventions offered and a significantly greater number of psychoeducation/supportive interventions offered collaboratively. It was discovered that discussions between psychology trainees and family medicine residents immediately after patient encounters occurred 50% of the time and involved issues of case conceptualization. These informal discussions may be an important source of behavioral health education for family medicine residents. This study adds to efforts to better understand what occurs during these encounters.

"Conversational Advice": A mixed-methods analysis of medical residents' experiences co-managing primary care patients with behavioral health providers

OBJECTIVE

When integrated behavioral health clinicians (IBHCs) and residents co-manage patients, residents may learn new approaches. We aimed to understand the effect of co-management on residents' behavioral health (BH) management learning.

METHODS

Residents completed a web-based survey enquiring: whether co-management included a shared visit and/or face-to-face meeting with an IBHC, whether residents received feedback from the IBHC, and what they learned. Qualitative responses were coded thematically using a constant comparative method.

RESULTS

Among 117 respondents (overall response rate 72%, 117/163), from five residencies recruited from 40 residencies with BH integration, residents were significantly more likely to receive feedback if they had a shared visit with the patient and an IBHC (yes 69% vs. no 33%; adjusted OR 3.0, 95% CI 1.2-7.6). Residents reported three major learning themes: interpersonal communication skills awareness, BH skills awareness, and newly adopted attitudes toward BH. Residents who received feedback were more likely to report themes of interpersonal communication skills awareness (yes 26.6% vs. no 9.4%).

CONCLUSION

BH integration promotes increased feedback for residents practicing face-to-face co-management with IBHCs, and a positive influence regarding residents' attitudes and perceived skills.

PRACTICAL IMPLICATIONS

Residency programs can meaningfully improve residents' learning by promoting face-to-face co-management with IBHCs.

Medical and pharmacy students shadowing advanced practice nurses to develop interprofessional competencies

AIM

This article describes a job-shadowing project that partnered second-year medical and third-year pharmacy students with an advanced practice nurse (APN) for a four-hour job- shadowing experience.

BACKGROUND

In order to address the Interprofessional Education Collaborative (IPEC) Expert Panel core competencies of interprofessional communication, teamwork, and roles/responsibilities, this project implemented a job-shadowing experience to increase students' knowledge of APN roles and interprofessional collaborative team practices.

METHODS

Forty volunteer medical and pharmacy students were paired together and completed the job-shadowing activity with an APN. Assessment of knowledge was measured by pre- and post-project surveys.

RESULTS

Pre- and post-job-shadowing differences demonstrated statistical significance in the interprofessional domains of role awareness, collaboration and communication. These results suggest that an APN job-shadowing experience is effective in developing medical and pharmacy students' competencies in interprofessional collaborative practice.

CONCLUSION

Specific recommendations include creating enhanced job-shadowing experiences within the curriculums of medicine, pharmacy, and nursing students, and assessing for evidence of enhanced IPEC competencies as a result of these learning experiences.