1. Inter-Professional academic/practice partnerships to improve disaster education for population health
Roberta P. Lavin, PhD, APRN-BC – Professor and Associate Dean for Academic Programs, University of Missouri at St. Louis Tener G. Veenema, PhD MPH MS FAAN – Associate Professor, Johns Hopkins School of Nursing Joanne C. Langan, PhD, MSN, BSN, BS/Edu, RN, CNE – Associate Professor, Associate Dean, Disaster Preparedness Coordinator, Saint Louis University School of Nursing Rick S. Zimmerman, Ph. D. – Associate Dean for Research, LSU, College of Nursing Rachel L. Charney, MD – Associate Professor, St. Louis University Daniel Barnett, MD, MPH – Associate Professor, Department of Environmental Health & Engineering. Johns Hopkins Bloomberg School of Public Health Keeta Holmes, Ed. D. – Director, Faculty Development, University of Missouri - St. Louis Annah Bender, Ph. D, MSW – Research Associate, College of Nursing, University of Missouri-St. Louis
This work is partially funded by an AACN and CDC cooperative agreement with University of Missouri – St. Louis, Saint Louis University, and Johns Hopkins University

2. Project Objective
This project sought to improve disaster education for population health through the establishment of inter-professional Academic/Practice partnerships and the creation of a toolkit to be used for primary care provider training.

3. Key components
Survey - needs assessment of public health schools and primary care training programs for disaster preparedness and response
Achieve consensus - Convene nine key stakeholders to review current population health competencies and identify current resources and curricular needs, identify remaining gaps, and develop a collaborative dissemination plan
Create, curate and disseminate a publically available toolkit
Written population health curricular training materials for partnership-based disaster preparedness and response with core content and educational methods
Related online curricular content that can be supported by a practical playbook like website
New success stories related to Flint water crisis, Zika, and Long-term health impacts of disaster/terrorism

4. Create and sustain education & training environments for population health
Colleges of Nursing
Medical Schools
Schools of Public Health
Health Departments
Hospitals
Veteran Emergency Management Evaluation Center
The United States needs a healthcare and public health workforce that possesses the knowledge, skills, and abilities to respond to any disaster or public health emergency in a timely and appropriate manner. Workforce readiness is critical to the success of any large-scale disaster response and to optimizing population outcomes. The absence of a clearly articulated vision and framework for disaster education is not without consequences. An unprepared workforce has the potential to limit the effectiveness of local, state and federal response plans, limit organization surge capacity and to negatively impact health outcomes in populations impacted by disasters.
This list of partners were key to what we wanted to accomplish.

5. Structured Analytic Approach
In-Depth Discussion
Document Review
Stakeholder Meetings
Surveys of Schools of Nursing/Med/PH
Expert Interviews
Access State/Local/University Training
Identify Essential Core Competencies
Synthesize the Data:
Explore
Ascertain
Verify
Evidence
Success Stories
Model Curriculum
Methods and Data: A multi-pronged approached was used to identify essential educational needs and core competencies, as well as to assess the status of integration of state and local-level population focused training. Data were synthesized from in-depth discussions with key informants, review of relevant documents, guided discussions at key partner stakeholder meetings, review and abstraction from available core competencies and other government planning documents, the survey of medical, public health, and nursing programs and interviews with experts.
Toolkit
Workshop
Test and Refine

6. Survey and Interview Student Total: 728
242 responses from 8 MPH programs
302 responses from 13 NP programs
184 responses from 11 DO programs
38 response from 1 MD program
Administrator Total: 68
9 MPH
51 NP
4 DO
4 MD
13 interview
Physicians
Public Health
Nurses
EMT
Emergency Manger
All had deployed
All had experience training responders or hospital personnel

7. knowledge, skills, and understanding considered to be weakest in Curriculum
Students
Administrators
Least covered in curriculum: 60% of MPH & DO students, and 70% of NP students identified the following were not covered at all:
Location and capabilities of shelters
Implementation of the Incident Command System
Connecting survivors with available resources
Processing and lines of communication and coordination among the various partners
25% of DO indicated most topics were not covered
75% or 100% of MD administrators indicated that almost every topic was not covered at all.
Topics least covered in curriculum: 35% or more of administrators of MPH and NP programs saying the following were not covered at all
Location and capabilities of shelters
Implementation of the Incident Command System
Connecting survivors to available resources
Processes and lines of communication
Implications of loss of community resources

8. Student Responses
The level of confidence a student had in their ability to respond was assessed using a Likert scale
1 = Not confident at all
7 = Extremely confident
The general consensus is that 7-point scales are better for highly educated populations (e.g. students and administrators) while 5-point scales are best for the general public. The literature reviews in the articles lend support for the use of Likert scales in sociological research. Hopefully that will forestall critics at the presentation! Weijters, B., Cabooter, E., & Schillewaert, N. (2010). The effect of rating scale format on response styles: The number of response categories and response category labels. International Journal of Research in Marketing, 27(3),   Revilla, M. a., Saris, W. E., & Krosnick, J. a. (2013). Choosing the Number of Categories in Agree-Disagree Scales. Sociological Methods & Research, 43(1),  

9. Administrator Data
The level of confidence faculty had in students’ ability was assessed using a Likert scale
1 = Not confident at all
7 = Extremely confident

10. Relationship to core competencies
Core competencies and sub competencies for Disaster medicine and Public health
Weakest areas identified by students and administrators
1.0 Demonstrate personal and family preparedness for disasters and public health emergencies
10.0 Demonstrate knowledge of legal principles to protect the health and safety of all ages, populations, and communities affected by a disaster or public health emergency
4.0 Communicate effectively with others in a disaster or public health emergency
3.0 Demonstrate situational awareness of actual/potential health hazards before, during, and after a disaster or public health emergency
Less than 50% of students had an emergency plan
Less than 50% of students said basic legal and regulatory issues were covered
Use principles of risk and crisis communication (2.74 – 4)
Refer matters outside of one’s scope through the chain of command ( )
Report unresolved threats to physical and mental health through the chain of command (3-4.37)
Core Competencies for Disaster Medicine and Public Health Lauren Walsh, MPH; Italo Subbarao, DO, MBA; Kristine Gebbie, DrPH, RN; Kenneth W. Schor, DO, MPH; Jim Lyznicki, MS, MPH; Kandra Strauss-Riggs, MPH; Arthur Cooper, MD, MS; Edbert B. Hsu, MD, MPH; Richard V. King, PhD; John A. Mitas II, MD; John Hick, MD; Rebecca Zukowski, MSN, RN; Brian A. Altman, PhD; Ruth Anne Steinbrecher, MPH; James J. James, MD, DrPH

11. Cross walk of competencies and survey data
The findings from the interviews supported this information. Most of the respondents could not say how they addressed population or how it applied. A frequent comment was we focus on the patient in front of us and that is what we train.
The respondents also express grave concern about the use of table top exercises that we too limited in who was included and did not include hands on experience for clinicians. One respondent said we are great at fire drills, but don’t ask us to actually evacuate patients because we do not practice that.
Overall personal preparedness was low, although significantly higher for NP students (mean 1.74/5 items present vs. 1.1 for MPH and 0.9 for DO students, p < 0.001)
Personal preparedness was positively correlated with:
having school preparedness plans (p < 0.001)
confidence in their abilities to respond to a disaster (p < 0.001), older age (p < 0.01)
curriculum coverage of disaster topics (p < 0.5).

12. https://disasternursing.org/toolkit/
Toolkit
The toolkit can be remixed through Thinglink so that it meets your needs.
We made all of the modules open to all and want them to remain free.
Creative Commons License. This work is licensed under a Creative Commons Attribution 4.0 International License.

13. What we know
Students were significantly more likely to have home preparedness if they had been impacted by a prior disaster (2.1 items vs 1.2, p < 0.001)
It must be a responsibility of the administration to ensure training of students and encourage their preparedness
Faculty and administration must lead by example
We aren’t leading if we aren’t covering the basics in our curriculum

14. What Can We Do
Advocate for student curriculum to include disaster preparedness
Focus on development of personal preparedness
Reminders—newsletters or routine announcements outlining what has been taught on disaster preparedness
Clear explanation for how to manage a disaster at the school
Collaboration: NP, MD, DO, MPH programs better prepared
Share content

15. Conclusions
Health professional students have low levels of personal preparedness across all disciplines
Administrator preparedness does not correlate with student preparedness
Schools can increase their preparedness at home by improving school preparedness and covering disaster topics in the curriculum, as well as by assessing student confidence in their abilities to respond to a disaster
Table tops and lectures do not take the place of hands on practice through drills or participating in any level of disaster
Wee need to work together to create content that can be incorporated into classes

16. Contact Information:
Roberta Lavin