Implementing and evaluating a community-based, inter-institutional, interprofessional education pilot programme

ABSTRACT

Many health professions programmes have begun integrating interprofessional learning into their curricula; however, community-based interprofessional education (IPE) initiatives are relatively scarce. The Meharry-Vanderbilt Alliance IPE Faculty Collaborative, comprised of faculty from five institutions, developed a community-based IPE programme that allowed students to engage in meaningful interprofessional activities while exposing them to social determinants of health. Thirty students from ten professions were divided into six teams and paired with three community organisations. Each team engaged community organisation staff and clients to develop practical solutions to their priorities. Teams participated in debriefings and team-building exercises to further support interprofessional learning. Students’ comfort working with others (CWO), value in working with others (VWO), and self-perceived ability (SPA) to work with others were assessed using the Interprofessional Socialisation and Valuing Scale (ISVS). Mean rank scores in all three subcategories increased significantly from baseline (CWO: z = −4.11, p < 0.0001; VWO: z = −3.41. p = 0.001; SPA: z = −2.79, p = 0.005). In addition, programme evaluations suggest the programme improved students’ understanding of social determinants of health. Our findings align with those of two other community-based IPE initiatives and support the expansion of IPE efforts beyond traditional settings.

KEYWORDS:

• Community–academic partnerships
• education
• graduate
• interprofessional collaboration
• interprofessional education
• professional competence

Introduction

Despite the notable increase in interprofessional education (IPE) programmes, opportunities for students to engage in interprofessional learning are often limited (Garr, Evans, & Cashman, 2008) and occur mostly in academic or clinical settings (Abu-Rish et al., 2012). Broadening the scope of IPE initiatives to include nonclinical settings, such as community-based IPE programmes, can expand avenues for interprofessional learning and increase the number of available IPE opportunities. Community-based IPE programmes may also produce the added benefit of exposing students to concepts that might not be accounted for, or explicitly taught, in all health professions curricula, such as social determinants of health and cultural competence (Ryan, Vanderbilt, Mayer, & Gregory, 2015).

Background

The Meharry-Vanderbilt Alliance IPE Faculty Collaborative is located at Meharry Medical College, one of the oldest and largest historically Black academic health science centres in the southeast United States. The Alliance is a collaboration between Meharry Medical College and Vanderbilt University Medical Center and has a focus on community-engaged initiatives. The Collaborative consists of a group of voluntary faculty, representing five institutions and ten professions, who create innovative models for inter-institutional IPE. In an effort to broaden the scope and breadth of interprofessional learning opportunities available to health professions students, the faculty developed a community-based IPE programme. The purpose of this initiative was to create an interprofessional programme that allowed students to engage in collaboration and shared problem-solving to address the needs of nonprofit, community organisations and their clients. Programme activities were designed to promote changes in attitudes and behaviours that aligned with interprofessional competencies outlined by the Interprofessional Education Collaborative (2016). The specific aims of the programme were to determine the feasibility of integrating IPE into a nontraditional setting and assess the effects of a community-based IPE programme on students’: (1) ability to participate in shared problem-solving and shared decision-making, (2) comfort with team-based roles, and (3) value of teamwork, including appreciation for client involvement and working with people from different professions.

Program description

Three nonprofit community organisations, serving clients effected by substantial disparities in health outcomes, agreed to participate in the IPE collaborative programme. Community organisations hosted interprofessional teams of students interested in identifying and addressing gaps between client needs and the services being provided.

Thirty students from ten professional programmes and five universities were selected by their respective programmes to participate in the pilot programme. Recruitment strategies and selection criteria varied by programme. Participation was voluntary; however, some academic programmes permitted students to apply this experience to mandatory community service hours or service-learning electives. Students were assigned to one of six interprofessional teams, and the teams were paired with the community organisations. Staff from each community organisation volunteered to guide students through the process of engaging clients, identifying areas of client need, and developing solutions that may improve client experiences.

The programme included both a didactic, preparatory phase and a service-learning phase. During the 2-month preparatory phase, students and staff from each community organisation participated in approximately 11–14 h of training and team-building activities. The curriculum included (1) cultural competence and health disparities, (2) ethics, (3) principles of community engagement, (4) designing and implementing focus groups, and (5) other topics as needed (e.g., HIV education for students engaging clients living with HIV). Team-building activities, such as peer-led discussions, interactive exercises, and debriefings, were key components of the training sessions. These activities provided opportunities for teams to engage in open dialogue and improve communication.

After training was completed, students progressed into the 4-month service-learning portion of the programme, which consisted of 20–24 h of client engagement and shared problem-solving. Teams facilitated focus groups with clients from each of the community organisations to identify client-specific needs and priorities. Students and staff from the community organisations also conducted interviews and informal community discussions to gather additional information and engage clients in shared decision-making (Figure 1). Throughout the service-learning phase of the programme, students participated in reflection and debriefing sessions in order to share perspectives, discuss professional knowledge related to client needs, and clarify team-based roles and responsibilities.

Figure 1. Project engagement and process

Teams worked with staff from their assigned community organisation to develop a tool or resource that aligned with unmet client needs. All tools and resources developed were given to the community organisations after programme completion.

Methods

A quasi-experimental, single group study design was used to determine whether the programme successfully met the aims of improving students’: (1) ability to participate in shared problem-solving and shared decision-making, (2) comfort with team-based roles, and (3) value of teamwork. A modified pre–post structure allowed data to be collected before, during, and after the programme.

Data collection

The Interprofessional Socialisation and Valuing Scale (ISVS), a validated tool (King, Shaw, Orchard, & Miller, 2010), was used to evaluate changes in students’ self-perceptions related to shared problem-solving, comfort with team-based roles, and value of teamwork. This tool was designed to be used primarily in clinical settings; however, many of the scale items are applicable to nonclinical settings.

The ISVS is a 24-item tool with three subscales: self-perceived ability (SPA) to work with others, comfort working with others (CWO), and value of working with others (VWO). Items in the SPA category relate to students’ perceived ability to engage in shared problem-solving, including comfort in shared decision-making. The CWO category captures students’ perceived confidence in fulfilling team-based roles and comfort communicating with team members. Statements categorised as VWO assess the level of importance or appreciation students placed on team-based approaches, client involvement, and working with other health professionals.

The ISVS was administered three times during the pilot programme: before the programme (T1), after training (T2), and after the programme (T3). Students rated their level of agreement on a 7-point Likert scale (7 being the highest and 1 being the lowest).

Student satisfaction surveys were administered at the conclusion of the programme. The satisfaction survey consisted of closed-ended questions pertaining to specific programmatic elements, such as training content and required hours.

To further explore perceived programme effects and capture changes in perceptions, students were encouraged to share one lesson learned during an event held at the conclusion of the programme. Comments on lessons learned were free-form and captured in various modalities (e.g., written, verbal, and video recorded).

Data analysis

Descriptive statistics were used to characterise the sample. Due to the lack of normality within the data, Friedman’s analysis of variance tests were used to assess change in ISVS sub-scores across three time points. Significant omnibus tests (significance set at p < 0.05) were followed up with post hoc pairwise comparisons using Wilcoxon signed rank tests with a Bonferroni correction (p < 0.017). All analyses were performed using SPSS version 23 (Chicago, IL).

Ethical considerations

Prior to programme implementation, the need for Institutional Review Board (IRB) approval was explored. According to the Vanderbilt University Medical Center IRB, approval was not necessary because the project was education and quality improvement focused. Participation by students, community organisation staff, and organisation clients was voluntary. Clients participating in focus groups, interviews, or community discussions received a grocery store gift card for $25 as a nominal gift.

Results

Twenty-seven of the 30 participating students completed the programme; 24 students completed all surveys; thus, only the results of these 24 students follow. Students represented ten professions: dentistry, dietetics, divinity, medicine, nursing, occupational therapy, pharmacy, public health, social work, and speech and hearing sciences. The majority of students were women (70.8%), the mean age was 24 years, and most students were enrolled in a graduate level programme (91.7%).

In the SPA to work with others category, there was no significant change following the training (SPA: z = –1.26, p = 0.2); however, in the categories of value and comfort working with others, the scores did significantly increase after training compared to baseline scores (VWO: z = −2.70, p = 0.007; CWO: z = −3.88, p < 0.001). The mean rank scores of all three ISVS categories significantly increased after programme completion when compared to baseline scores (Figure 2) (SPA: z = −2.79, p = 0.005; VWO: z = −3.41, p = 0.001; CWO: z = −4.11, p < 0.0001).

Figure 2. Interprofessional Socialization and Valuing Scale (ISVS) mean rank results

Student satisfaction surveys revealed that 91.7% (n = 22) of students would recommend this programme to other students. Approximately 83% of students were satisfied (n = 14, 58.3%) or very satisfied (n = 6, 25%) with the overall content of training and team-building sessions, and 75% were satisfied (n = 15, 62.5%) or very satisfied (n = 3, 12.5%) with the number of required hours. Three students (12.5%) reported being very dissatisfied and eight students (33.3%) reported being somewhat satisfied with the timing of the programme during the academic school year.

Free-form comments on lessons learned paralleled programme aims. Students reported “our [clients] were the most important part of our team,” “different [professions’] perspectives all played a role in our deliverable,” and “I’ve learned to appreciate the role each profession plays in the giant scheme of healthcare.”

Some students also expressed changes in perception related to cultural competence and social determinants of health, such as: “[the program] broke down stereotypes I initially had about the population,” “I will take a more holistic approach with my patients, understanding [the] challenges that affect their health,” and “[the program] helped me see how economic, environmental, and social factors affect health”.

Discussion

Consistent with two existing community-based IPE initiatives (Ryan, Vanderbilt, Mayer, & Gregory, 2015; Tsang, Cheung, & Sakakibara, 2016), our findings suggest community-based IPE initiatives may produce positive changes related to teamwork and team-based competencies. The significant increase between before (T1) and after programme (T3) ISVS scores implies that our programme may have improved students’ self-perceived value of teamwork, comfort with team-based roles, and ability to participate in shared problem-solving and decision-making. These findings align with those of Tsang et al. (2016), which show a significant increase in students’ self-perceived team-based competency and team cooperation following participation in an interprofessional community service project.

Lessons learned shared by students reinforce the programmes’ utility in increasing students’ appreciation for client involvement and value of working with students from other professional programmes. Ryan et al. (2015) reported similar findings from their community-based IPE programme, specifically noting improvements in students’ comfort working with diverse patients and comfort working in interprofessional teams.

Though our findings compliment those of Ryan et al. (2015) and Tsang et al. (2016), we are unable to fully compare our results to either programme due to differences in evaluation tools and study design. While our programme similarly employed a pre–post test design, we also included a mid-point assessment to determine whether changes occurred between the preparatory and service learning phases of the programme. Significant increases between all three ISVS scores in the comfort (CWO) and value (VWO) categories suggest that both the preparatory and service learning phases of our programme positively affected students’ appreciation for teamwork and comfort working with others. In contrast, the preparatory phase may not have been as influential in increasing students’ self-perceived ability to work with others, since scores in this category did not change significantly between baseline (T1) and after training (T2). This may be due to the lack of opportunities to engage in shared decision-making and problem-solving during the preparatory phase.

Results presented in this article need to be interpreted with caution, given the small number of students. The generalisability of our findings is further limited by the self-reported nature of the data and the lack of a comparison group. During the pilot programme, students progressed in their respective academic programmes, which may have confounded the results and affected participation. Students informally shared that conflicts between their academic schedules, extracurricular pursuits, and team project activities made participation more difficult.

Questions remain regarding the extent of benefit to community organisations and the populations they serve. Evaluating the long-term effect of the programme on the community was not a primary objective of this pilot programme, but the authors recognise the importance of assessing benefits to the community organisation and clients in future iterations. Faculty and community organisation satisfaction will also be included in future evaluation efforts.

Despite the limitations, our findings support the use of community-based IPE programmes and suggest teamwork outside of the traditional clinical and academic contexts of most IPE programmes may be effective. Feedback from students expressing changes in understanding of social determinants of health and reduced stereotypes leads us to further posit that community-based IPE could be instrumental in teaching concepts related to health disparities and cultural competence.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Acknowledgments

Faculty from ten professions and five institutions participated as volunteers in this project. In addition to the authors, these faculty included: Leah Alexander, PhD, MPH, School of Public Health, Meharry Medical College; Katharine Baker, PhD, Vanderbilt Divinity School, Vanderbilt University; Beth Hallmark, PhD, RN, College of Health Science, Belmont University; Elizabeth Heitman, PhD, Vanderbilt University Medical School, Vanderbilt University; Barbara Jacobson, PhD, Hearing and Speech Sciences, Vanderbilt University Medical Center; Christian Ketel, DNP, MSN, Vanderbilt School of Nursing, Vanderbilt University; Rebecca Moore, formerly of Tennessee State University; Sandra Rosedale, formerly of Belmont University; Carrie Szetela, PhD, School of Medicine, Meharry Medical College; Elizabeth Wolff-Robinson, MeD, Dietetics, Vanderbilt University Medical Center.

Funding

This project was supported by resources from the Vanderbilt Institute for Clinical and Translational Research (VICTR) 6 UL1 TR000445-11 and the Meharry Clinical and Translational Research (MeTRC) U54 MD0007593.

Additional information

Funding

This project was supported by resources from the Vanderbilt Institute for Clinical and Translational Research (VICTR) 6 UL1 TR000445-11 and the Meharry Clinical and Translational Research (MeTRC) U54 MD0007593.