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

Figures & data

Figure 1. BU CHAMPs Practice Model

Table 1. Structure of the interprofessional care clinic.

Activity	Time	Description
Case-Based Didactic	40 min	Utilize skills learned in prep-work to practice and work through cases as a team. May include standardized patients for in-depth practice.
Team Huddle	20 min	Trainees review scheduled patients, create an agenda for each visit as a team, set roles and learning goals. Faculty facilitation provided.
Patient Visits	2 hrs	Up to 3 patient visits of 40 min each. All student providers in the room with the patient at once. Faculty supervision provided.
Debrief	30 min	Facilitated discussion & reflection on team-based collaboration and patient-centered care with faculty facilitation to identify best practices and areas for improvement.
EHR Documentation	30 min	Care plan documented in EHR with faculty supervision. Time permitting, outreach to patients who no showed/scrub chart for following week.

Figure 2. Data Collection Time Points Abbreviations: ISVS: Interprofessional Socialization & Valuing Scale; ICCAS: Interprofessional Collaborative Competency Attainment Scale; II: Individual Interview; RIPC: Review of Interprofessional Competencies; TBFG: Team-Based Focus Group (the IP trainee team(s) at each site); DSFG: Discipline-Specific Focus Group (uniprofessional groups of trainees from across all sites)

Table 2. Demographic data – trainees, preceptors, patients.

	N	Age		Gender		Race*														Ethnicity
				Female		American Indian/Native Alaskan		Asian		Black/African American		Native Hawaiian/ Pacific Islander		White		Other		Not Reported		Hispanic
		Mean(SD)	Range	N	%	N	%	N	%	N	%	N	%	N	%	N	%	N	%	N	%
Trainees	35	25.3(3.4)	22–40	25	71.4%	2	5.7%	6	17.1%	0	0.0%	0	0.0%	30	85.7%	0	0.0%	0	0.0%	3	8.6%
Preceptors	15	41.1(9.2)	29–62	13	86.7%	0	0.0%	1	6.7%	1	6.7%	0	0.0%	12	80.0%	1	6.7%	0	0.0%	1	6.7%
Patients	42	50.7(11.1)	26–74	30	71.4%	0	0.0%	0	0.0%	28	66.7%	2	4.8%	10	23.3%	0	0.0%	2	4.8%	7	16.3%

*Persons who identify as multiracial were counted more than once

Table 3. ICCAS scores – all trainees & by discipline.

	All			Dietetic Interns			Medical Students			Physician Assistant Students			Social Work Interns			P-value†
Time Point	N	Mean	SD	N	Mean	SD	N	Mean	SD	N	Mean	SD	N	Mean	SD
Retrospective-Pre	35	4.46	0.98	14	4.43	1.01	7	3.71	1.09	7	5.23	0.56	7	4.51	0.58	0.028
Post	35	6.41	0.54	14	6.46	0.36	7	6.23	0.95	7	6.68	0.36	7	6.25	0.40	0.358
Change	35	1.96*	0.95	14	2.03*	0.97	7	2.52*	1.17	7	1.45*	0.67	7	1.74*	0.69	0.175

*P < 0.01 by paired t-test.

^†By ANOVA.

Table 4. ISVS-21 scores – all trainees & by discipline.

	All			Dietetic Interns*			Medical Students			Physician Assistant Students			Social Work Interns			P-value^†
Time Point	N	Mean	SD	N	Mean	SD	N	Mean	SD	N	Mean	SD	N	Mean	SD
Earliest	21	5.37	1.14	1	-	-	7	5.14	1.54	7	5.89	0.52	6	4.97	1.16	0.319
Latest	35	5.81	0.79	14	5.82	0.76	7	5.88	0.81	7	6.01	0.48	7	5.54	1.13	0.735
Change	21	0.47***	0.60	1	-	-	7	0.74**	0.79	7	0.12	0.42	6	0.53**	0.43	0.159

*One dietetic intern completed the ISVS at two post-semester time points, therefore mean score was not calculated for that time point and a change score was not calculated for the group.

**P < 0.05 by paired t-test.

***P < 0.01 by paired t-test.

†By ANOVA.

Table 5. RIPC scores – total & subscales.

Time Point	N	Total		IP Communication		Roles & Responsibilities		Teams & Teamwork		Values & Ethics
		Mean	SD	Mean	SD	Mean	SD	Mean	SD	Mean	SD
Baseline	16	89.69	21.99	2.81	0.72	2.91	0.90	2.93	0.85	3.23	0.70
Post	16	103.60	18.63	3.85	0.66	3.45	0.63	3.57	0.67	3.66	0.67
Change	16	13.94*	23.73	0.35	0.79	0.54*	0.96	0.65*	0.89	0.43*	0.77

*P < 0.05 by paired t-test.

Table 6. Qualitative themes.

Themes	Trainee Quotations
Patient-Centered Care:	“A patient came in, mainly concerned about her housing and secondary concerns included her eating habits. So the first visit we focused largely on her housing situation, so social work stepped up, and took the major lead in that session. Then we were able to bring things full circle in the next session to really hone in on the nutrition part of things with her diabetes. It felt good to have the patient feel like they left with more help each time, focusing on the patient’s priorities and the patient’s order. I think that builds a lot of trust.” (Medical Student #4)
Interprofessional Roles & Responsibilities:	“It did kind of start out where the nutrition student or practicum student were asking all the nutrition questions. So, maybe there was a slight like monopolizing of time at first. But as we got more comfortable with the visits and we saw how we interacted, our medical student would take on a little bit of the nutrition questioning and things like that. So, we started to rotate those roles. We’d say like, “Okay, why don’t you start off and get their chief complaint. What brings the patient in today?” So, the social worker would start with that. So, we started to shift those roles.” (Physician Assistant Student #4)
Team Dynamics:	“So the dietetic intern was trying to educate the client to add some carbohydrates to have some energy throughout the day. Then the medical student said, “Well what about whole grains?” I understand that the medical student just wanted to recommend something healthy but from my dietetic, nutrition background we should not be giving her too much on the plate, cause it seems like she has a lot to deal with in her life right now. We also don’t have sufficient information for us to actually just prescribe her and let’s say with brown rice. We have no idea if she actually enjoys brown rice or if she actually cooks for her family. So if she cooks brown rice, if her family does not like it, then that means that she needs to cook two batches which means more workload. We actually ended up talking about that at the end of the clinic.” (Dietetic Intern #5)
Lessons Learned:	“I think a lesson learned for me is that you can’t do everything by yourself. Like I think my dream going to medical school is like oh I’ll become a doctor, I’ll know so much, I’ll find these patients, I’ll fix all their problems, I’ll make sick people healthy! But really you can’t do it by yourself. You need the help of people in other professions. You need to rely on other people.” (Medical Student #5)