Rutgers, The State University of New Jersey Joining Forces Collaboration An Interprofessional Learning Activity Carol A. Terregino, M.D. Senior Associate Dean for Education (interim) Master Educators’ Guild Symposium Rutgers Biomedical and Health Sciences March 17, 2014.

Robert Wood Johnson Medical School SERVICE

Robert Wood Johnson Medical School A LABOR OF LOVE “To colleagues whose tireless activities to get the message out to the nation—you have inspired me. I think I am a better person because I have learned from you.” Special thanks to Robert Like for his collaboration, Chris Molloy and Joe Barone for believing in Me and supporting the endeavor, The JF Kennedy Hospital, and Peter Amenta for signing on to the AAMC initiative and charging me to get it Done.

Robert Wood Johnson Medical School White House initiative to serve military personnel and families in employment, education and wellness Charge from the Association of American Medical Colleges RWJMS joined over 100 medical schools in pledging to participate The contribution: A transformative educational program to train cohorts of learners in the health professions each year

Robert Wood Johnson Medical School Why is this initiative important? 15 million of the 23 million US veterans seek care in the community rather than VA system In NJ, 443,200 veterans, 73% are wartime veterans Impact factor of these veterans’ service: –1,329,600 connected and impacted by war and/or service The Stories

Robert Wood Johnson Medical School INTERPROFESSIONAL INNOVATIVE COLLABORATION FOR LEARNERS ACROSS EDUCATIONAL SPECTRUM Learner collaboration: medical students, pharm d students, nursing students, graduate students in social work and psychology, residents in psychiatry, primary care, and physical medicine and rehabilitation Beyond RBHS, Beyond RWJUH Faculty collaboration: MD/DO in family medicine, psychiatry, physical medicine and rehabilitation, acute care surgery, emergency medicine, pharm d, doctoral trained nurses, psychologists, social workers Facilitators: including orthotics, physical and occupational therapy, behavioral health, veterans and family members, students

Robert Wood Johnson Medical School What is innovative? INTERPROFESSIONAL INNOVATIVE COLLABORATION FOR LEARNERS ACROSS EDUCATIONAL SPECTRUM Warrior-Centric Healthcare (WCHT) TM by The Steptoe Group BASED UPON RECOMMENDATIONS FROM Rand Report: Invisible wounds of War DoD Prevention of Suicide by Members of the Armed Services DoD Recovering Warrior Task Force Report “immediate and unabated need for the implementation of warrior-centric evidence-based assessment and training” of health providers First time such a program was used in an academic environment with interprofessional health professions students

Robert Wood Johnson Medical School Joining Forces with The Steptoe Group

Robert Wood Johnson Medical School

What is our Vision for Educational Collaboration? Annual interprofessional training of a cohort of learners to meet the total health and healthcare needs of our service members, veterans, their families and communities Outcomes: Enhanced awareness Improved communication Warrior-centric care Collaborative care plans

Robert Wood Johnson Medical School Implementation Collaboration with the Steptoe Group to tailor the learning to interprofessional students*** Train the Trainer-full day session (40 trainers) –20 faculty with terminal degrees –20 facilitators with military/veteran experience/family member contact/clinical contact with veteran Training of students and residents-full day session (400 students/residents) –Facilitated small groups, interactive –Online avatar case studies and assessments at 3,6,and 9 months for all learners ***significant modifications

Robert Wood Johnson Medical School What are the Learning Modules? Military and veteran culture in the clinical setting Cultural competency in the military and veteran communities Neurobiology of post-traumatic stress disorder and traumatic brain injury Provider communication in the military and veteran communities RWJMS Modifications based upon training –More engaged learning –Role play –CAT scans, Drugs and Brains –Practical strategies

Robert Wood Johnson Medical School Specifics of the Educational Program 1. technology – videos and avatars 2.adult learning principles in large and small groups Interactive Reflection and sharing Impact factor Personal connection 3.target the knowledge and performance of healthcare providers, allied health team members, and service support personnel 4.Durable solutions: approach to complex patient scenarios and knowing where to access help for veterans

Robert Wood Johnson Medical School Joining Forces in the Patient Centered Medicine Curriculum

Robert Wood Johnson Medical School 400 Strong, impacted by an evocative video of voices of warriors, now students at Rutgers

Robert Wood Johnson Medical School Panel of warriors and family members

Robert Wood Johnson Medical School Small Group Interaction Each room had a faculty facilitator from one of the professional schools as well as a veteran, significant other or family member of the veteran –Ground rules –Ice breakers Time for reflection Interdisciplinary groups of 4 for role play Development of a collaborative care plan for a veteran form the perspective of the various professions

Robert Wood Johnson Medical School Dr. Prescott lending his expertise in small group

Robert Wood Johnson Medical School Role playing in interprofessional scenarios

Robert Wood Johnson Medical School Teaching with Role Play An E7 warrior presents to the emergency department at 5:30 am with severe jaw pain. He is in the reserves, awaiting deployment but not yet called up. He needs to be at training at 7:00 am. Why you never call an enlisted serviceman SIR? Four Acts –The Triage Nurse –The Physician/Physician Assistant/Nurse Practitioner –The Mental Health Provider –The Community Pharmacist

Robert Wood Johnson Medical School Warriors lending their perspective to the collaborative care plan

Robert Wood Johnson Medical School

Outcomes-based upon 167 pre and post test matched data

Robert Wood Johnson Medical School

Pre and Post Test Unmatched Preliminary Data – Survey by Kevin Parks, MD candidate Pre – test n=151Post – test n=205Sig. “I feel uncomfortable screening / history taking a veteran of the Armed Forces.” 2.2 (0.8) 1.9 (0.8) P=.001 “When I gather patient histories, I ask (will ask) about veteran status.” 2.1 (1.1)4.2 (0.7)P=.001 “I am aware of resources available to veterans to help meet their healthcare needs. 2.5 (0.9)3.7 (0.8)P=.001

Robert Wood Johnson Medical School More outcomes

Robert Wood Johnson Medical School

Lessons Learned Power of Stories Power of the Patient as a player in “interprofessional” education Power of health professions student as “faculty” Time for reflection Limit didactics Avatars?

Robert Wood Johnson Medical School Questions, Comments, Future Directions Invitation to attend the June 23, 2014 event? Invitation to Joining Forces with RWJMS to become the Regional Training Site for Warrior-Centric Care? Rutgers National Center for Educating Health Professionals, Welcoming veterans and families who receive care outside of the VA system, Educating Rutgers Veterans, Treating PTSD Traumatic Brain Injury