President's Teaching Scholars Program

Marylou Robinson

Assistant Professor
University of Colorado Anschutz Medical Campus
College of Nursing
Division of Adult and Elder Health
13120 E. 19th Ave Room 4117 (Ed II North)
Mail Stop C288-19
Aurora, CO 80054
(303) 724-8564
Marylou.robinson@ucdenver.edu
Pilot of Interprofessional Learning of Advanced Assessment Skills

A. What is the central question, issue or problem you plan to explore in your proposed work?
Can a classroom based course be successfully taught using an Intraprofessional Education (IPE) approach? The Anschutz Medical Campus (AMC) has been successful in launching IPE programs such as Ethics and Team Steps Simulation training under a major effort of the REACH initiative (Realizing Educational Advancement for Collaborative Health). Clinical site rotations involving cross disciplinary team providers are underway . Integration of students across disciplines has also occurred with the CU UNITE effort to bring health care to the underserved. In this spirit, the College of Nursing (CON) and the School of Medicine (SOM) propose a pilot project to integrate one section of a course in Fall 2012 for Physical Assessment utilizing the facilities of the Center for Advancing Professional Excellence (CAPE) with the author of this grant proposal as PI.

B. Why is this central question, issue or problem important to you and to others?
The AMC was founded with a dream of IPE as a fundamental pathway to develop the health care practitioners of the future. The vision was far greater than just having shared classroom and public gathering space. A transformation of teaching and learning in discipline specific silos to a more integrated and shared experience would foster team building, interprofessional communication and mutual respect all with the central focus of providing patient centered care. The Institute of Medicine report encourages cross disciplinary collaboration to help foster this vision. Because APNs such as Nurse Practitioners will be the backbone of primary care in the future, it follows that the university (CU) that pioneered the first Nurse Practitioner program in the USA once again take the lead in offering clinically focused IPE in the classroom.

The Director of the SOM Foundation of Doctoring courses (Dr W. Madigosky, MD) and the Acting- Director of the CAPE (Dr J. Fisher, DNP) have agreed with the Director of the Masters & Doctor of Nursing Practice programs of the CON (Dr V. Erikson, PhD) to pilot a IPE section of Physical Assessment in Fall 2012. Currently both the SOM and CON use the resources of the CAPE to provide similar coursework. A core shared feature is the use of Standardized Physical Exam Teaching Associates (SPETA) at the CAPE. The outlines for presentation and testing of material are exactly the same for both student cohorts. They share the same testing rubics. Outcomes are equivalent. The only major difference is the day of the week class is in session.
A one day experiment of dropping in an RN into most MD groups in Fall 2011 was a successful venture per the feedback from faculty, both student cohorts and the CAPE staff. Because all graduate CON students are practicing RNs, they provided insight into real clinical situations for the SOM students they joined for that day of class. The SOM students were impressed by the professionalism of the nurses and the CON students were happy to see that future physicians were open to sharing learning experiences with them. The major negative was the one day “drop in” effect of the RN stranger joining a SOM team that had already bonded. This issue will be overcome by having the RN join the group at the beginning and remain with them for all six of the SPETA rotations to learn physical exam skills together every week.

C. How do you plan to conduct your investigation?
(A May 2012 consultation with COMIRB indicates the following proposal will probably result in an exempt status).
The PI will oversee one section (11-13 volunteer graduate RN students) of NURS 6761 Advanced Assessment as they join the newly admitted SOM students in learning Physical Assessment. One CON student will join a team of 3 SOM students for these rotations. SPETA are already familiar with teaching both student groups. Because the SOM starts the academic year 10 days prior to the CON academic schedule (August 17 vs August 27th), the Foundations of Doctoring faculty will orient the medical student teams randomly chosen to incorporate an RN into their group for the pilot study. Students who strongly object will be transferred to another team. The PI will orient the volunteer CON students to the study and provide the link back to their nursing peers simultaneously taking the course in the standard CON only format.

The medical students will have class on 17 August without the RNs. The content focus is basic vital signs, a subject that RNs are very experienced with so do not have to repeat. The RNs will join the groups for the second day of class and remain with them until the testing period around 8 October. The IPE student groups and the traditional SOM and CON students will take the same hands-on skills demonstration tests. After the testing period, the SOM students rotate to another course. The CON students will continue together as a section within the traditional CON format that continues to learn more assessments (covered in the SOM in Spring) for the rest of the CON semester.

As part of the orientation of both student cohorts, a survey will be distributed eliciting their attitudes and feelings about IPE. The topics will include items such as preconceived notions of the other student group, fears and anxieties and what they hope to take away from the experience. At the end of the testing period, the survey will be distributed again to determine whether there was a change. Focus groups will be held of student volunteers from both cohorts to gain additional insight. Groups will be facilitated by the PI and SOM faculty. Survey tools previously developed by Thomas Jefferson University (TJU) are hoped to be used for this portion of the study.

Qualitative focus group data will be analyzed for common themes by the PI. Data from the surveys will be processed using SPSS software with descriptive and inferential statistics for analysis. Both survey and focus group results will be reviewed by the SOM and CON faculty to help determine lessons learned and whether the pilot was a success. If so, then integration of the entire student cohorts from both programs would be considered for Fall 2013.

D. How might you make your work valuable to others in ways that facilitate scholarly critique and review, and that contribute to thought and practice beyond the local?
It is intended to present study findings at AMC forums including the REACH and other IPE forums, plus at regional and national conferences as poster or podium presentations. Because both SOM and CON students are involved, presentations venues extend from nursing education groups to academic medicine conferences, to include the prestigious annual TJU Intraprofessional Educational Conference.

Several universities are following TJU’s lead in implementing IPE, learned that combining disciplines into one classroom is fraught with potential pitfalls (Goodman, 2012). Movement toward integration of preparation for the new health care teams makes sense; however, it steps on the toes of tradition, professional isolation and academic territoriality. This study is but one step toward finding a solution where all parties win, especially patients.

On a local level it provides several positives: a) Helps extend the dream of IPE at the AMC; b) provides avenues for students of each discipline to gain insight into shared commonalities of future practice; c) t may possibly gain economy of effort for teaching these foundational courses in the future; d) keeps CU on the cutting edge of pioneering innovation in medical roles and education.

E. Literature Review of the theory and effective teaching practice of the subject:
IPE is not new, but a concept fielded on occasion over 100 years ago. Multiple competing political and professional issues have restricted its widespread adoption. In 1972 the Institute of Medicine resurrected this old theme with a “revolutionary call” for implementation, but not until 1999 did the idea catch on with change of focus toward the patient, not the professions. TJU has taken the lead in gathering the multiple international universities and agencies expanding their IPE horizons by hosting the annual JCIPE (Jefferson InterProfessional Education Center) conference. Current topics of research presented at the May 2012 sessions included lessons learned from incorporating students into IPE teams (Spickard, 2012), development of IPE faculty ( Ward, 2012; Smith et al., 2012) and development of tools to capture student attitude and opinion about IPE ( Weber, et al., 2012; Giordano, et al, 2012; & Ruebling, et al., 2012). Much research has been with a geriatric care focus with proven positive patient outcomes. A few years of experience with IPE at major universities have started to compile a larger volume of evidence and opinion about IPE programs. Approaches successful in one region, have failed in others, but the momentum is gaining that this is the way all health professionals will be taught in the future.

F. What is your record of innovations in teaching and/or the assessment of learning?
I am a PTLC 2011 cohort member. I have successfully completed that research and presented the findings at a major research conference in April 2012. I am known in the CON as someone who is pushing for excellence and fostering needed change. This pilot project has slowly developed over several years of talking with the CAPE. The ground work is completed. I have dreams of incorporating more CAPE SIM into the graduate program. I am an active member of the group designing the innovative opening course sequence of the new undergraduate nursing curriculum starting 4 June 2012 . I currently am also investigating the unexpected (but thankfully limited) finding of dosage calculation issues within the advanced practice student cohort. Those initial findings will be presented at the National Quality and Safety in Nursing Education conference in Tucson, AZ on 1 June 2012.

Name and contact information for a mentor/Coach for your project?
My current PTLC mentor Dr. Ernestine Kotthoff-Burrell,PhD, Assistant Professor CON has a long term nursing education focus resulting in policy and curriculum revolutions. She has successfully built on her PTLC grant into a HRSA grant that will impact the entire state of CO. She is very familiar with COMIRB from her work with doctoral students. 13120 E 19th Ave, Room 4228 . College of Nursing, Mail Stop C288-19, Aurora, CO 80046. Phone; 303-724- 8565; email: Ernestine.Kotthoff-Burrell@ucdenver.edu.

If your project is selected, as you willing to serve as a coach in the PTLC in a future year? Yes, I look forward to someone working with me to take this to the next levels of study or to guide them in their own.