A Pilot Study to Incorporate Interprofessional Education with FNP Students in an Online Program with Pharmacy Students in a Traditional Program Using a Blended Approach Andrea Collins, DNP, NP-C, CNE, COI Cyndi Cortes, DrPH, MSN, CPNP-PC, COI

Interprofessional Education When students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes (WHO, 2010) Definition AACN - interprofessional collaboration expectations in Essentials for baccalaureate, master’s, and doctoral education for advanced practice Other disciplines (i.e., pharmacy, physical therapy, speech and language pathology) have also incorporated IPE into accreditation standards Regulatory Expectations Prepare students for future collaborative practice to the benefit of individuals, populations, and care delivery systems. Purpose

Core competencies for Interprofessional Collaborative Practice (IPEC expert panel, 2011) Values and ethics Work with individuals of other professions to maintain a climate of mutual respect and shared values Roles and responsibilities Use the knowledge of one’s own role and those of other professions to appropriately assess and address the healthcare needs of the patients and populations served Interprofessional communication Communicate with patients, families, communities, and other health professionals in a responsive and responsible manner that supports a team approach to the maintenance of health and the treatment of disease. Teams and teamwork Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan and deliver patient/population-centered care that is safe, timely, efficient, effective, and equitable.

Strategies Needs assessment Institutional support Identify and train an interdisciplinary IPE team Design the IPE curriculum Pilot implementation Evaluate effectiveness

Identify & train an interdisciplinary IPE team At least one faculty member from each participating disciplineHighly recommend Interprofessional Education Collaborative (IPEC) for 1 st groupPoints to address in training: IPE What is it and why is it needed Importance to your institution Role biases Understand roles and responsibilities and scope of each discipline Develop strong collegial collaborative relationships Responsibilities in IPE activities Creating Facilitating Debriefing Resources for IPE What is available Where to find it Opportunities for collaboration in your setting

IPE curriculum design Intentionality of interactions Episodic events or interdisciplinary courses Online, face-to-face, or hybrid Graduate or undergraduate or both Available space Timing within each program related to level of knowledge Number of students in each program for equitable representation in groups Available trained faculty

Activity Design Core trained faculty group Routine faculty meetings/communication Clear faculty roles Assignment or experience Congruent with current level of student knowledge Grading criteria and impact to course grade Consistent communication (who/how) with students

Graduate IPE Pilot Program Is there a significant difference in students’ attitudes about IPE before and after the interprofessional education experiences? 50 beginning Family Nurse Practitioner students and 123 third year pharmacy students 21 month timeframe until graduation Initial and ending face-to-face sessions on campus, then online discussion forum assignments.

Curriculum Design Student groups Approximately 2 FNP to 5 pharmacy students IPE non-credit course in LMS for 21 months All students enrolled All activities occur in this course Initial and ending face-to-face meetings Online discussion/assignment each semester Related to didactic content current to each program Faculty member of each discipline graded their students

Timeline for IPE pilot project Pre-IPE survey Face-to-face Meet and Greet Average 2 online activities per semester for 5 semesters Pre- graduation post-IPE survey Pre- graduation Wrap-up meeting

Initial FNP/Pharmacy Interaction Name/FNP or Pharmacy student Where are you from originally? Where do you currently live? What is your work experience in health care? What is it that makes you want to become a FNP/pharmacist? What is the main thing that a FNP/pharmacist will bring to the health care team? What is a job responsibility of a FNP/pharmacist that you think other health care professionals may not know? At the Meet and Greet Session, each student asked of his or her group members: What is the most important thing that you learned as a result of your conversation today? What is the most surprising thing that you learned as a result of your conversation today? After the session, students answered the following questions on discussion board of online IPE course :

Assignment Examples Face-to-face Meet and Greet Session Get to know group members Discuss specific scope of practice questions Online Discussion Questions Scope of practice Rational prescribing Medication or diagnosis specific patient education Practice implications for recent health care trends or policy changes Online Quizzes 8 case scenario questions related to medication and disease management with subsequent group discussions of rationale and evidence for correct and incorrect answers Wrap-up meeting What was learned about the other discipline

Practical Issues Differences in curriculum of each program Differences in philosophy of patient care Faculty personality and preferred teaching/evaluation methods Faculty/student comfort with online activities Online vs. traditional program Students out of sequence in program

Assessment and Evaluation Almost 100% until last semester No real resistance from students Participation Pilot group - pre-pilot and prior to graduation Surveys of student IPE knowledge and perceptions Based on participation Pass/Fail for pharmacy students 1% of course grade for FNP students Grading Criteria

Pilot Results 38 FNP students (86%) and 99 PharmD students (88%) completed both surveys ▫Matched pairs Not all students completed their programs of study with the same cohort of students Not all students completed both surveys Paired t-tests

Demographic Characteristics Item FNP (n, %) PharmD (n, %) GENDER: Female26 (68%)75 (76%) Male12 (32%)24 (24%) AGE: 30 years old or younger14 (37%)94 (95%) Older than 3024 (63%)5 (5%) EDUCATION: Less than a Bachelor’s degree13 (34%)55 (56%) At least a Bachelor’s degree25 (66%)44 (44%)

Statistically Significant Favorable Attitude Change (PharmD) 15. I have/had a clear understanding of my professional role when I interact/interacted with other health care students. FNP4.32 PharmD * 16. I have/had a clear understanding of the roles that other health care students have when they interact/interacted with me. FNP PharmD *

Statistically Significant Favorable Attitude Change (FNP) 21. I would need/need to have face-to-face interactions with health care students in order for effective interprofessional education to occur. FNP * PharmD

Statistically Significant Non-favorable Attitude Change 11. I could learn/learned valuable aspects about patient care by working with others from different health care professions. FNP PharmD *** 18. I am interested in interprofessional education. FNP PharmD ** 14. I do not believe that interprofesssional interactions regarding patient care will be/are relevant to me as a health care student. FNP PharmD *

Response Trends (Same Direction) 10. I believe that interprofessional patient care teams could decrease health care costs. FNP PharmD I am confident about the beneficial skills that I personally can bring/brought to an interprofessional interaction with other health care students. FNP PharmD I am comfortable communicating with others through online discussion boards. FNP PharmD

Response Trends (Different Directions) 7. I believe that interprofessional education is important for health care students to experience. FNP PharmD I believe that interprofessional education could help to improve patient health outcomes. FNP PharmD I believe that medication errors may be prevented by better interprofessional patient care. FNP PharmD

Study Limitations IPE process changed for PharmD students halfway through the 21 month experience Wording of Item 18 should have been “I am interested in online interprofessional education. “ PharmD students had one F2F IPE experience with other health profession students in addition to the online IPE experience Comparison of experiences could have occurred

Study Conclusions Results are inconclusive PharmD students asked not to have IPE assignments in their P4 year Consider other types of assignments Case studies Simulations Webinars

Future Considerations Start IPE from the beginning of a program to reduce role biases Introduce online learning component to students before requiring online IPE

Tips for IPE success IPE curriculum structure Mix of courses and episodic activities TRAIN faculty TOGETHER Model collaboration Intentional, designed student interactions Facilitation and debriefing

References Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, DC: Interprofessional Education Collaborative. World Health Organization. (2010). Framework for action on interprofessional education & collaborative practice. Geneva: World Health Organization. Retrieved from _eng.pdf _eng.pdf