Interprofessional education in the clinical learning environment: a mixed-methods evaluation of a longitudinal experience in the primary care setting

ABSTRACT

Team collaboration in our healthcare workforce is necessary to effectively address multifaceted medical and social needs, especially for those impacted by systemic inequities. Effective interprofessional practice and education models including curricula are needed to prepare a practice ready healthcare workforce for team collaboration. Most healthcare trainee interprofessional experiences take place episodically in classroom settings. However, creating a culture that supports team-based learning and interprofessional clinical practice requires teaching skills (e.g., communication, collaboration, shared decision-making, coordination of care) longitudinally in the clinical setting. A weekly interprofessional clinic for patients/clients with chronic health conditions was organized in three primary care practices. Trainees from nutrition, social work, medicine, and physician assistant programs worked with supervising clinicians from each field. Surveys, interviews, and focus groups assessed the effects of interprofessional education and training in the primary care setting. Results show the longitudinal experiential IPE program significantly improved knowledge, attitudes, skills, and values addressing key interprofessional competencies. Qualitative results complement survey data and highlight key themes addressing patient-centered care and team dynamics. These findings demonstrate the importance of longitudinal, immersive team-based interprofessional training in the clinical learning environment.

KEYWORDS:

• Interprofessional education
• longitudinal curriculum
• primary care
• clinical learning environment
• mixed-methods evaluation

Acknowledgments

The authors would like to acknowledge and thank the members of the initial grant writing team and curriculum contributors Molly Cohen-Osher, MD, MMedEd, Paula Gardiner, MD, MPH, Karla Damus, PhD, MSPH, MN, RN, Katherine Gergen-Barnett, MD, Lauren Scott, MD, PhD, and Suzanne Mitchell, MD. Special thanks to the patients, staff, leadership, and providers at participating health centers. We also thank grants administrator Jess Howard, research assistants Amanda Gorton, Rachael Manasseh, and Manvi Lohia, and Spanish translators Chrystel Murrieta and Walker del Aguila Ortiz.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website

Additional information

Funding

This work was supported by the Health Resources & Services Administration under grant Health Resources and Services Administration T0B30021;.

Notes on contributors

Heather H. Miselis

Heather Miselis, MD, MPH, FAAFP, is a board-certified family physician providing inpatient and outpatient clinical care in Boston, MA. She is an Assistant Professor of Family Medicine and leads the interprofessional education curriculum at Boston University School of Medicine. As Principal Investigator of Boston University Community Health Alliance of Medical Professionals (BU CHAMPs), she has worked with others to develop an IPE and collaborative practice model in the primary care environment that addresses the quadruple aim. Her mixed-methods research evaluates the impact of interprofessional practice and education on health professional trainees and providers as well as patient and healthcare outcomes.

Stacey Zawacki

Stacey Zawacki, DrPH, RDN, is a Clinical Assistant Professor of Nutrition in the Department of Health Sciences at Boston University, and Director of the BU Sargent Choice Nutrition Center. A licensed, registered dietitian with a Master’s degree in Exercise Science and a Doctoral degree in Public Health, Dr. Zawacki has 20 years of experience specializing in cardiovascular disease risk factor management for diverse populations. She is a faculty leader for Boston University Community Health Alliance of Medical Professionals (BU CHAMPs), a HRSA grant designed to train students from multiple healthcare professions to work collaboratively in interprofessional teams treating underserved populations.

Susan White

Susan White MD, FACCOG is a generalist obstetrician–gynecologist with 20 years’ experience. Now at Boston Medical Center and an Assistant Professor of Obstetrics & Gynecology, she’s been involved in Physician Assistant education since 2007. As director of the PA Program at Boston University School of Medicine and founding Director of Didactic Education, she implemented a model combining PA and medical students in a Medicine, Disease, and Therapy course, making BU one of two PA programs to combine students. She developed an interactive curriculum on social determinants of health and served on a BUSM/Northeastern University planning committee for interprofessional activities

Leanne Yinusa-Nyahkoon

Leanne Yinusa-Nyahkoon is an occupational therapist with 20 years experience serving children and families from urban communities of color. Dr. Yinusa-Nyahkoon is a Clinical Assistant Professor in the Department of Occupational Therapy, Research Scientist in the Department of Family Medicine, and Research Associate in the Department of Obstetrics and Gynecology, all within Boston University. Dr. Yinusa-Nyahkoon’s research focuses on examining maternal and child health disparities and interprofessional care within urban community health centers. As a qualitative expert she values examining clients’, health professional trainees’, and health care providers’ perceptions of the environmental and social factors that contribute to health inequities.

Carol Mostow

Carol Mostow LICSW, an Assistant Professor of Family Medicine at Boston University School of Medicine, has trained and supported residents and faculty for 30 years at Boston Medical Center. She is the lead author with physician colleagues of the 2010 JGIM RESPECT model for communicating across power, difference and race with patients and learners and a subsequent DocCom module and podcast using RESPECT to build equitable, supportive, inclusive healthcare teams. A graduate of Yale, Simmons, and the Academy on Communication in Healthcare where she joined the national faculty, she also facilitates interprofessional rounds for the Schwartz Center for Compassionate Healthcare.

Janice Furlong

Janice Furlong, MSW, LICSW, is a Clinical Associate Professor at Boston University School of Social Work. She is a four-time recipient of BUSSW’s Teaching Excellence Award. In 2015, she received Boston University’s highest teaching award, the Metcalf Cup and Prize for Excellence in Teaching. Her practice and scholarly interests include interprofessional collaboration, development and evaluation of learner-centered teaching methods, gender bias in clinical practice, and clinical supervision. Ms. Furlong has forty years of clinical practice experience with children, families, and adults in a variety of inpatient and community mental health settings.

Katherine K. Mott

Katherine Mott, BA, is a Research Coordinator for CHAMPs, an interprofessional healthcare training program located in the Department of Family Medicine at Boston University. She has supported the CHAMPs program since its inception in 2016. She worked as a clinical research coordinator at Mass General Hospital in the Department of Neuroradiology, and as a research assistant in Brigham & Women’s Department of Neurology. Her educational background is in cognitive neuroscience, with over 12 years of experience in research settings.

Anika Kumar

Anika Kumar, BS is a Research Coordinator at the Health Equity Research Lab located in the Department of Psychiatry at Cambridge Health Alliance. She supported BU CHAMPs’ research initiatives for two years as a Research Assistant in the Boston Medical Center Department of Family Medicine. Her lead on qualitative research methods for the BU CHAMPs program highlights the nuances of team building, patient experience, and interprofessional clinical practice. Her educational background in Community Health and Psychology lends her to pursue evidence-based, community-centered research.

Michael R. Winter

Michael Winter, MPH, is Associate Director, Statistical Programming, at the Biostatistics and Epidemiology Data Analytics Center (BEDAC) at Boston University School of Public Health. He has over 30 years’ experience in data management and statistical analysis of quantitative public health and medical data and has co-authored more than 150 publications. His research interests include the areas of addiction, persons living with HIV, and LGBT health. Flora Berklein, MPH, is a Statistical Programmer at the Biostatistics and Epidemiology Data Analytics Center (BEDAC) at Boston University School of Public Health. Her research interests include racial health equity, addiction, and maternal health.

Brian Jack

Brian Jack, MD, is Professor and former Chair of the Department of Family Medicine at Boston University School of Medicine. He is active in research and dissemination of preconception care. The health IT system based on this work is now being disseminated in Lesotho in southern Africa, where he directs the Lesotho-Boston Health Alliance. His team created the “ReEngineered Discharge” program described in the book “50 Studies Every Physician Should Know” for which he received the 2013 Peter F. Drucker Award for Non-Profit Innovation. He is a member of the National Academy of Medicine.