Nurse-Doctor Co-Teaching: A Pilot Study of the Design, Development, and Implementation of Structured Interprofessional Co-Teaching Sessions

Figures & data

Figure 1 Blueprint for assessment of Nurse-Doctor Co-Teaching sessions. Timeline highlighting the two-week interval between the Kickoff Dinner and first co-teaching session and the three-month interval between the pre- and post- Collaboration Surveys given to nurses and residents. Each of the ten Nurse-Doctor Co-Teaching sessions was evaluated by an overall rating survey.

Table 1 Responses from Anonymous Nurse and Resident Learner Surveys after Each Nurse-Doctor Co-Teaching Session

	Overall Rating^a			Rated “Enjoyable”^b			Rated “Effective”^c			Wants Additional Sessions^d
Co-Teaching Session	n	Mean	s	n	Mean	s	n	Mean	s	n	Mean	s
A	14	1.21	0.426	14	1.21	0.426	14	1.29	0.469	14	1.00	0.000
B	10	1.10	0.316	10	1.10	0.316	10	1.20	0.632	10	1.10	0.316
C	16	1.19	0.403	17	1.24	0.437	17	1.24	0.437	17	1.00	0.000
D	11	1.00	0.000	11	1.18	0.405	11	1.18	0.405	11	1.00	0.000
E	13	1.15	0.376	13	1.15	0.376	13	1.23	0.439	13	1.00	0.000
F	12	1.33	0.492	12	1.42	0.515	12	1.33	0.495	12	1.00	0.000
G	10	1.10	0.316	10	1.10	0.316	10	1.30	0.483	10	1.10	0.316
H	14	1.43	0.514	14	1.86*	0.663	14	1.71	0.607	14	1.07	0.267
I	12	1.17	0.577	12	1.42	0.669	12	1.17	0.389	12	1.08	0.289
J	8	1.13	0.354	8	1.88	0.641	8	1.63	0.518	8	1.00	0.000

Notes: ^a“Overall, how would you rate today’s session?” (1 = Excellent/4 = Poor). ^b“How enjoyable was today’s session?” (1 = Very enjoyable/5 = Not enjoyable at all). ^c“How effective were the methods of teaching in today’s session?” (1 = Very effective, 5 = Not effective at all). ^d“Would you like to have additional co-teaching sessions?” (Yes/No). *Statistically higher than all sessions except Session F, Session I and Session J at p-value < 0.05 level.

Table 2 Topics of the Ten Co-Teaching Sessions and the Number and Types of Interactive Teaching Strategies Used in Each Session

Topic of Co-Teaching Session	Number of Interactive Teaching Strategies	Types of Interactive Teaching Strategies Used in Co-Teaching Session
Arterial Blood Gases	1	Matching Columns
Alcohol Withdrawal	2	Video with Scoring, Turn and Talk
Hyponatremia	1	Image Analysis
Interruptions on Medical Units	3	Stand Up-Sit Down, Back-to-Back and Face-to-Face, Turn and Talk
C. difficile Diagnosis & Treatment	2	Polling, Hands-On Activity
Opioid Withdrawal	3	Polling, Turn and Talk, Case Discussion
Telemetry	3	Stand Up-Sit Down, Turn and Talk, Hands-On Activity
Catheter Associated Urinary Tract Infections	4	Turn and Talk, Case Discussion, Polling, Design
H. pylori Diagnosis and Treatment	3	Turn and Talk, Polling, Hands-On Activity
Venous Thromboembolism	3	Turn and Talk, Polling, Design

Table 3 Description of the Interactive Teaching Strategies Used in Nurse-Doctor Co-Teaching Sessions

Interactive Teaching Strategy	Description
Back-to-Back and Face-to-Face	In pairs, participants stand back-to-back, listening to a prompt or question. They have 30 seconds to think about their response. Then, once the facilitator indicates the time is up, participants turn and face each other to discuss.*
Case-Based Discussion	Participants are introduced to a patient case and are asked to discuss the case at key moments, in pairs and/or as a whole group.
Design	In teams, participants are challenged to design a solution to a clinical problem. For example, in one session they designed an improved female urinary catheter.** In another, they were asked to design a discharge education sheet for patients who had been diagnosed with a venous thromboembolism.***
Hands-On Activity	Participants actively engage in “Hands-On” activities. For example, learners placed jellybeans on a diagram of the torso in the correct locations of telemetry leads.
Image Analysis	Participants look at an image, often a mystery image. They write or discuss what they notice and wonder about the image.
Matching Columns	Participants are asked to match the item in Column A with an associated item in Column B.
Polling	Participants are polled for their responses to multiple choice questions using tools such as the Immediate Feedback Assessment (IFAT) Cards.****
Scoring	Participants score a scenario or case using an established rubric. For example, participants used the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) to practice scoring a patient with alcohol withdrawal.
Stand Up-Sit Down	Participants share their thinking about a statement by standing up if they think the statement is true and staying seated if they think it is false, or vice versa.
Turn and Talk	Participants share their thinking about a question, problem, or scenario with their neighbor (s).

Notes: *Data from ElEducation.org. Expeditionary Learning: Classroom Protocols. Expeditionary Learning. Available from: https://curriculum.eleducation.org/sites/default/files/curriculumtools_classroomprotocols_053017.pdf Back-To-Back and Face-To-Face, Page 8.³² **Supplementary Appendix 5. ***Supplementary Appendix 6. ****Immediate Feedback Assessment Technique, Epstein Educational Enterprises, Inc., Cincinnati, Ohio.

Table 4 Verbatim Comments from Anonymous Nurse and Resident Learner Surveys on What the Learners Liked Best about the Co-Teaching Session, Organized by Top Seven Categories of Response

“What Did You Like Best about Today’s Session?”	Anonymous Nurse Responses	Anonymous Resident Responses
1. Interactive	“Paired discussions” “It was very engaging and interactive!” “Being able to ask questions”	“Interactive with clear takeaways” “Seeing capsules + tubes, better appreciation for logistics” “Hands-on, visual experience” “Scratch cards” “Catheter design! Fun and interactive”
2. Hearing Both Nurse and Doctor Perspectives	“Excellent co-presentation of both MD and RN perspective” “Great dual perspectives!” “Seeing both sides”	“The fact that we got to hear from nurses too!” “Hearing/learning from both perspectives” “Learning about nursing driven protocol” “Good to better understand each other’s point of views”
3. Cases/Scenarios	“Activities/case studies” “Scenarios” “Case study”	“Case-based questions” “The quiz with review” “Teaching on specific guidelines” “Practical cases” “Case was good, chatting with non-MDs”
4. Collaboration	“Collaboration between RN and MDs = better patient care!” “Very good teamwork” “Collaboration with MD/nursing, very informative”	“Always great to collaborate out of the high stress environment on the floors” “Led by both MD and RN” “Teamwork emphasis, physician + nurse collaboration” “Shared with RN colleagues”
5. Relevant, Important and/or Practical	“Real life examples” “Can apply to practice” “Teaching was straightforward and effective” “Subject we deal with daily” “Helpful topic, relevant”	“Good mix of learning points for RNs and MDs” “Very relevant topic and good use of different teaching methods” “Nurses point of view, very practical” “Effective teaching methods” “Practical info on treatment”
6. Interdisciplinary/Interprofessional	“I love the collaboration between disciplines” “The interdisciplinary discussions”	“Interactive, interdisciplinary, relevant” “Interdisciplinary interaction”
7. Brief/Short	“Key points, not too long” “Brief and informative” “Excellent communication with great knowledge of topic”	“Brief, but very informative” “Interactive, brief” “Short, relevant” “Clear explanations”

Figure 2 Top anonymous nurse and resident responses to the question “What did you like best about today’s session?” Responses are from nurse and resident learner surveys collected after each Nurse-Doctor Co-Teaching session, where n = 8 to 17 surveys depending on the session. Categories of anonymous responses are listed on the Y axis. Frequency of responses (X axis) represents the number of survey responses in each category totaled over the ten co-teaching sessions.

ElEducation.org. Expeditionary Learning: Classroom Protocols. Expeditionary Learning. Available from: https://curriculum.eleducation.org/sites/default/files/curriculumtools_classroomprotocols_053017.pdf. Accessed October 01, 2019.

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