President's Teaching Scholars Program

2014 Research Projects

 

Krista Estes, DNP, FNP-C

Assistant Professor

University of Colorado, Anschutz Medical Campus

College of Nursing

Division of Women, Children and Family Health

13120 E. 19th Ave.

Mail Stop C288-18, ED2N, Room 4310

Aurora, CO 80045

Krista.Estes@UCDenver.edu

Breaking Down the Silos: Fostering an Interdisciplinary Approach to Learning Advanced Physical Assessment

A. What is the central question, issue or problem you plan to explore in your proposed work?

PICO Questions: Do graduate nursing students in an interdisciplinary Advanced Physical Assessment class with first year medical students compared to students in a traditional Advanced Physical Assessment class score a higher mean on the Standardized Physical Assessment Teaching Associates Final? What are the students’ perceptions and attitudes of interdisciplinary education before and after an integrated Advanced Physical Assessment course?

The Anschutz Medical Campus (AMC) was built with the inspiration and ambition of providing a rich interdisciplinary environment. In the past years, this has come to fruition through the implementation of multiple interprofessional educational (IPE) programs. While these programs have greatly enriched the students’ education, there are minimal IPE classroom experiences with college of nursing (CON) graduate students. Students in various disciplines are taking many of the same courses, but in silos. An example is Advanced Physical Assessment. This course is taken by both the graduate nursing students and the undergraduate medical students with the same Standardized Physical Exam Teaching Associates (SPETAs), in the same Center for Advancing Professional Excellence (CAPE) lab, with many of the same teaching standards. By providing a shared IPE classroom environment among these two disciplines, there is the potential to enhance the students’ education through learning mutual planning, decision making and goal setting. Therefore, the silos can begin to be broken down.   

B. Why is this central question, issue or problem important to you and to others who might benefit from or build on your findings?

The delivery of healthcare in American has become complex and as a result, there is role differentiation and specialization. While there are multiple disciplines in healthcare, there is one commonly shared goal: improvement of patient outcomes.  To meet this goal, it is important for there to be mutual respect and understanding among all disciplines. There should not be competition, but collaboration. This begins with a shared educational experience.

In the Fall 2012 semester, Dr. Marylou Robinson implemented a pilot project integrating 1 CON graduate student with 3 students from the School of Medicine (SOM) in the CAPE. These students used teamwork to learn advanced physical assessment skills on SPETAs. Using the Readiness for Inter-Professional Learning (RIPL) survey, attitudes of student’s about IPE pre and post event were measured.  It was through Dr. Robinson’s vision of transforming teaching and learning in discipline specific silos to a more integrated and shared experience that Dr. Estes became very interested in IPE education.

The idea of IPE education is not new. For years programs have tried to implement IPE experiences, but many fail or continued implementation is given up due to its daunting nature. The American Association of Colleges of Nursing recommends the development of curricula that incorporate opportunities for graduate nursing students to work together with other disciplines and recognize shared content and clinical experiences. The role of the educational process in IPE in comparison to traditional methods is not well studied; therefore, continued implementation of this IPE experience on a larger scale while evaluating methods to maximize the educational experience and educational outcomes is essential. Our goal is to build upon Dr. Robinsons’ PTLC 2012-2013 grant by implementing a similar study, but on a much larger scale and with more comparison of traditional learning versus the IPE experience. 

C. How do you plan to conduct your investigation? What sources of evidence do you plan to examine? What methods might you employ to gather and make sense of this evidence?

Dr. Robinsons’ 2012-2013 study involved 11 volunteer graduate RN students of NURS 6761 Advanced Physical Assessment with 33 newly admitted SOM students in learning IPE Advanced Physical Assessment. For 2013-2014, the goal is to incorporate entire student cohorts of 60 graduate nursing students with the estimated 166 SOM students. Groups will consist of 2 graduate nursing students with 2 SOM students for a more discipline balanced IPE experience. Since the SOM begins their academic year 10 days prior to the CON academic schedule, the first CAPE lab session will be used to orient the medical students to basic vital signs. The graduate nursing students will join medical students for the second day of class and remain with them for the remaining seven weeks of SPETA sessions.  After the completion of their sessions, both student cohorts will take the same SPETA physical assessment final. CON student grades will be compared retrospectively to a semester with the traditional learning format.

Prior to and after the IPE experience, the RIPL survey will be distributed to the CON students. At the end of the IPE experience, the PI and SOM faculty will conduct focus groups to gain additional insight. The focus groups will get qualitative analysis using thematic analysis. Data from the surveys will be processed using SPSS software with descriptive and inferential statistics for analysis. Data results will be reviewed by the CAPE director, SOM and CON faculty to identify areas of strengths and weakness, as well as ways to improve the IPE learning experience for students in the future.  Dr. Robinsons’ initial pilot went through expedited COMIRB so that information gathered within the pilot grant is accessible in this second study.  Expedited COMIRB is planned for continuation of this project in the future.

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?

The University of Colorado is known to be a pioneer not only through research, but also education. This IPE experience would extend IPE education at the AMC. Its outcomes will provide a valuable framework and example of a trial model of IPE education for various healthcare disciplines and programs of education to evaluate for possible development and implementation. The process, outcomes, limitations, and potential educational benefits related to IPE education can be further explored. This study would be made available to others through dissemination of findings at the university, regional, and national level. Poster and podium presentations as well as publication in a respected, peer-reviewed journal will facilitate this.

E. Include a literature review of the theory and effective teaching practice of the subject of your inquiry in order to locate your research in the literature preceding it.   

The Institute of Medicine (2010), calls for nurses to be full partners with other health care professionals in redesigning health care in the United States. It emphasizes IPE learning to reduce errors and encourages pre-graduation learning to foster communication and develop respect for the strengths of each discipline. A 2001 literature review examining IPE in healthcare identified that most of the existing literature evaluated academic activities and failed to compare IPE with traditional methods of learning (Hall & Weaver, 2001). Since, there continues to be minimal literature comparing these learning methods in the health care field. Dillon, Noble, and Kaplan (2009) evaluated IPE collaboration with nursing and medical students using clinical simulation and studied the students’ perceptions of the learning experience. As a result of the IPE simulation exercise, a significant difference was found in the medical students' posttest scores for collaboration and nursing autonomy. The nurses also viewed the nurse-physician relationship became more collaborative after the experience. Both cohorts felt that the experience should be continued.

F. What is your record of innovations in teaching and/or the assessment of learning?

Dr. Estes has always been an advocate for innovative teaching and learning. Six months after graduation from her family nurse practitioner program, she started a program of student integration for clinical rotations in the emergency department. Although she had limited clinical experience, it was important for students to observe how a practicing NP used resources to answer difficult clinical questions. Student evaluations of this clinical experience were excellent.

Upon becoming a faculty member a little over a year ago, Dr. Estes has served as a fresh viewpoint on old practices. In the courses she has been assigned to teach, she has made changes to improve the educational and learning experience of students. For example, in teaching Advanced Pharmacology and talking with faculty who have taught the course in the past, she identified that students have a difficult time learning to write prescriptions. As a result, she and another faculty member are in the process of developing an innovative educational module based on commonly identified prescribing errors to assist graduate students in learning to write prescriptions. The literature review and research study plan has been presented at the 24th Annual Rocky Mountain Interdisciplinary Research & Evidence-Based Practice Symposium, Collaborating to Improve Practice through Research & Evidence-Based Practice.

Dr. Robinson has held two PTLC grants 2011-2012 and 2012-2013 at the AMC.  As noted before, she has pioneered this effort of IPE with the SOM.  She has enlisted the endorsement of this idea from the Director and Assistant Director of the CAPE, and the Foundations of Doctoring faculty.  Her role will be to mentor Dr. Estes in expanding the pilot work as well as mentoring her in the PTLC process. 

G. Are you able to attend the required meetings?

Both investigators are able to attend the “required” meetings, although attendance to these meetings is seen more as being a privilege than a requirement. The benefits of these meetings are numerous. We really look forward to learning about the research projects of other PTLC scholars as well as presenting our research and receiving feedback from peers.

H. Name and contact information for a mentor/Coach for your project

Dr. Marylou Robinson, PhD, FNP-C, Assistant Professor at the University Of Colorado College Of Nursing, will serve as mentor. She is a 2011 and 2012 PTLC scholar and has a real heart for implementing IPE education.

Address: University of Colorado Anschutz Medical Campus, College of Nursing, Division of Adult and Elder Health, 13120 E. 19th Ave Room 4117, Mail Stop C288-19, Aurora, CO 80045; Phone: 303-724-8564, Email: Marylou.robinson@ucdenver.edu

I. If your project is selected, will you serve as a coach in the PTLC in a future year?

Yes, both would be honored to serve as a coach in the future.


References

Dillon, P., Noble, K. & Kaplan, L. (2009). Simulation as a Means to Foster Collaborative Interdisciplinary

Education. Nursing Education Perspectives, 30(2), 87-90.

Hall, P. & Weaver, L. (2001). Interdisciplinary education and teamwork: a long and winding

Road. Medical Education, 35(9), 867-75.

Institute of Medicine (2010). The Future of Nursing: Leading Change, Advancing Health. Retrieved from

 http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx

Robinson, M. Pilot for Inter-Professional Learning of Physical Assessment Skills. Podium presentation at the Western Institute of Nursing Conference in Anaheim, CA, April 13, 2013.