Rosalind Franklin University of Medicine and Science
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In response to the Institute of Medicine Committee on Quality of Health Care in America’s recommendation that health care professionals work in interprofessional teams, Rosalind Franklin University of Medicine and Science (RFUMS) developed a Curriculum Integration Task Force to “promote distinctive integration of health professionals’ education.” This group then created two required Interprofessional Healthcare Teams courses to educate students to work together in collaborative interprofessional teams, while understanding the concepts of social responsibility, current health care issues, prevention, patient-centered care, cultural competency, population/community health and advocacy. The courses are integrated into all first year clinical curricula and has been part of the educational process since 2004 at RFUMS.
An integral part of this curriculum is the interprofessional prevention education service learning project. The purpose of our Interprofessional Prevention Education Service project is to promote Prevention Education in the areas of Physical Fitness, Preventive Screening, Nutrition, and Making Healthy Choices.
After taking the Interprofessional Healthcare and Culture course mandated to all first year on-campus students, students themselves wanted to do more. In 2013 they established a community-based free clinic offering services. This is one of the few student-run clinics in the country. Underserved and underrepresented populations are served: to date, over 200 visits with over 100 clients.
Student volunteers from the university in allopathic, podiatric, nursing, pharmacy, physical therapy, physician assistant, and psychology work at the clinic, with many others waiting for rotations at the clinic. They seek to provide patient care in: behavioral health, diabetes education, women’s health, podiatric care, pharmacological consulting, physical therapy, and health screenings. Faculty volunteers from various professions oversee the students.
An integral part of this curriculum is the interprofessional prevention education service learning project. The purpose of our Interprofessional Prevention Education Service project is to promote Prevention Education in the areas of Physical Fitness, Preventive Screening, Nutrition, and Making Healthy Choices.
After taking the Interprofessional Healthcare and Culture course mandated to all first year on-campus students, students themselves wanted to do more. In 2013 they established a community-based free clinic offering services. This is one of the few student-run clinics in the country. Underserved and underrepresented populations are served: to date, over 200 visits with over 100 clients.
Student volunteers from the university in allopathic, podiatric, nursing, pharmacy, physical therapy, physician assistant, and psychology work at the clinic, with many others waiting for rotations at the clinic. They seek to provide patient care in: behavioral health, diabetes education, women’s health, podiatric care, pharmacological consulting, physical therapy, and health screenings. Faculty volunteers from various professions oversee the students.
impact
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Each year, 480 first-year students from 8 health professions take two 1-credit required IPE courses. |
Created a student-run interprofessional clinic on serving 100 underserved patients, and employing Spanish-speaking interpreters. |
Developed and strengthened collaborations with 31 health care agencies and community partners.
APTR project proposal for 2007/2008 IPE institute
Rosalind Franklin University first proposed the development of an "Interprofessional Prevention Education Service project" in 2007. The purpose of the project was to promote prevention education in the areas of physical fitness, preventive screening, nutrition, and making healthy choices. Over 450 first year students from 9 healthcare professional programs would complete interprofessional service projects in these areas. First we completed a pilot project with 3 interprofessional teams of students and then the full project with 23 interprofessional teams of students.
During the Interprofessional Healthcare Teams course that is mandatory for all incoming students in the 9 clinical on-campus programs, each student was assigned to an Interprofessional team of 15 students. Each team planned and participated in a service learning project. At the end of all of the projects, the students displayed posters describing their projects and discussed their reflections on their projects in their interprofessional team. The community partners were invited to the poster presentations.
As a result of this initial IPE prevention initiative, eighteen of the thirty-two interprofessional groups participated in prevention education projects with local community partners. Each group spoke to between 20 and 100 people. Therefore, 360 to 1800 people were the recipients of the preventive education.
We have been concentrating our service learning projects on prevention education since 2007. Over the last 4 years, more than 400 students have completed 23 to 32 projects per year. Countless number of community residents have been served. The following survey results are from some of the prevention screening and education sessions. The majority of the students surveyed agreed that the training sessions were adequate. All of the students agreed that the community benefited from the project. Most of the students agreed that the projects allowed them to demonstrate social responsibility. Overwhelming the majority of the students felt that the project increased their exposure to cultural diversity; and the majority felt that it allowed them to collaborate interprofessionally. The vast majority of participants surveyed felt that the information was presented in a manner that was easy to understand and that it was useful. All agreed that the service learning projects should be continued in the future years. When asked what they learned, they responded that they learned about taking care of themselves, about checking for diabetes, about the need to exercise, and risk factors for certain diseases.
During the Interprofessional Healthcare Teams course that is mandatory for all incoming students in the 9 clinical on-campus programs, each student was assigned to an Interprofessional team of 15 students. Each team planned and participated in a service learning project. At the end of all of the projects, the students displayed posters describing their projects and discussed their reflections on their projects in their interprofessional team. The community partners were invited to the poster presentations.
As a result of this initial IPE prevention initiative, eighteen of the thirty-two interprofessional groups participated in prevention education projects with local community partners. Each group spoke to between 20 and 100 people. Therefore, 360 to 1800 people were the recipients of the preventive education.
We have been concentrating our service learning projects on prevention education since 2007. Over the last 4 years, more than 400 students have completed 23 to 32 projects per year. Countless number of community residents have been served. The following survey results are from some of the prevention screening and education sessions. The majority of the students surveyed agreed that the training sessions were adequate. All of the students agreed that the community benefited from the project. Most of the students agreed that the projects allowed them to demonstrate social responsibility. Overwhelming the majority of the students felt that the project increased their exposure to cultural diversity; and the majority felt that it allowed them to collaborate interprofessionally. The vast majority of participants surveyed felt that the information was presented in a manner that was easy to understand and that it was useful. All agreed that the service learning projects should be continued in the future years. When asked what they learned, they responded that they learned about taking care of themselves, about checking for diabetes, about the need to exercise, and risk factors for certain diseases.
Current IPE activity/project description
In response to the Institute of Medicine Committee on Quality of Health Care in America’s recommendation that health care professionals work in interprofessional teams, Rosalind Franklin University of Medicine and Science (RFUMS) developed a Curriculum Integration Task Force to “promote distinctive integration of health professionals’ education.” This group then created 2 Interprofessional Healthcare Teams courses (course reference numbers: HMTD 500 and 501) to educate students to work together in collaborative interprofessional teams, while understanding the concepts of social responsibility, current health care issues, prevention, patient-centered care, cultural competency, population/community health and advocacy. The course is integrated into all first year clinical curiculums and has been part of the educational process since 2004 at RFUMS. We conduct yearly end of session feedback meetings with students who volunteer to be part of the post evaluation process. That information is incorporated into the next year's courses.
An integral part of this curriculum is the interprofessional prevention education service learning project. The purpose of our Interprofessional Prevention Education Service project is to promote Prevention Education in the areas of Physical Fitness, Preventive Screening, Nutrition, and Making Healthy Choices. Specific objectives include:
• To collaborate with community partners to achieve their goals in the community
• Assist in prevention of certain epidemic healthcare issues
• Influence health care policy
• To demonstrate social responsibility for the accomplishment of select service contributions
• To experience cultural diversity in the community
• To collaborate as an interprofessional team to achieve a goal
• To reflect upon service learning
Four class periods and online study materials are devoted to service learning and prevention education. Prior to the first of the classes devoted to service learning, the students are asked to review the materials regarding service learning and prevention education on the online component of the course. Then the students are given a lecture on service learning including what service learning means and the goals we hope they will accomplish. In 2011, we are adding a lecture on stages of change and prevention education. In their small group sessions, students talk about what they have heard and begin the project selection process which is continued online. At the second class, the students plan their project, discuss the culture of the people with whom they will be interacting, and review the stages of change and prevention education material. Any other planning or discussion occurs on line. After the students have completed their project, a session is devoted to planning and designing a poster to be presented on the Service Learning Poster Day. The last service learning session is devoted to display of the posters and reflection of the activity and what they learned.
The intra-university support for these courses is incredible. All academic departments and several administrative departments in our University provide faculty/staff mentors and support. There is also outstanding collaboration with many agencies in Lake County. The county health department provides an update on the health concerns and population health statistics for the county and over 30 local schools and health care and social support agencies participate.
After taking the Interprofessional Healthcare and Culture course mandated to all first year on-campus students, students themselves wanted to do more. In 2013 they established a community-based free clinic offering services. This is one of the few student-run clinics in the country. Underserved and underrepresented populations are served: to date, over 200 visits with over 100 clients.
Student volunteers from the university in allopathic, podiatric, nursing, pharmacy, physical therapy, physician assistant, and psychology work at the clinic, with many others waiting for rotations at the clinic. They seek to provide patient care in: behavioral health, diabetes education, women’s health, podiatric care, pharmacological consulting, physical therapy, and health screenings. Faculty volunteers from various professions oversee the students.
Patients have complex needs, including co-morbidities, limited access, language barriers, transportation difficulties, lack of child-care, lack of understanding of payment sources, ability to navigate prescription filling processes etc. All of these challenges require care providers to be vigilant in efforts to assist patients through a complex health delivery system. It requires team approaches across professions especially in clinics.
A supervised and funded team is necessary to be able to successfully address these community needs in student-run free clinics (SRFCs). In the December 9, 2014 issue of JAMA, Sunny Smith, M.D. of University of California at San Diego, following a survey of student-run free clinics SRFCs concluded that “the lack of funding and sufficient faculty supervisors identified as the biggest challenges in SRFCs are actionable items because institutional support could help stabilize and improve these educational opportunities for years to come.”
Student volunteers from the university in allopathic, podiatric, nursing, pharmacy, physical therapy, physician assistant, and psychology work at the clinic, with many others waiting for rotations at the clinic. They seek to provide patient care in: behavioral health, diabetes education, women’s health, podiatric care, pharmacological consulting, physical therapy, and health screenings. Faculty volunteers from various professions oversee the students. They are hoping to expand services offered as well as times the free clinic is open. The Clinic is currently held on Thursday evenings.
They wish to expand patient services in areas such as women’s health, laboratory and imaging, pharmaceutical services and providing a transportation voucher program. Therefore grants can help students service the community better by providing assistance with laboratory fees, health assessment equipment (blood pressure cuffs, etc.), clinic supplies, computer needs and supply more vaccinations for clients.
The students are learning much about the social and quality issues embedded in the infrastructure of medical delivery resulting in better patient outcomes. The conclusion reached through the data in the October 2014 AAMC Analysis in Brief, Vol. 14, Number 10 was “ medical students who learn alongside students from a greater number of other health professions also report having a better understanding of collaborative, interprofessional care of patients, and significantly higher levels of overall satisfaction with medical training.” Our goal is to help them achieve this.
An integral part of this curriculum is the interprofessional prevention education service learning project. The purpose of our Interprofessional Prevention Education Service project is to promote Prevention Education in the areas of Physical Fitness, Preventive Screening, Nutrition, and Making Healthy Choices. Specific objectives include:
• To collaborate with community partners to achieve their goals in the community
• Assist in prevention of certain epidemic healthcare issues
• Influence health care policy
• To demonstrate social responsibility for the accomplishment of select service contributions
• To experience cultural diversity in the community
• To collaborate as an interprofessional team to achieve a goal
• To reflect upon service learning
Four class periods and online study materials are devoted to service learning and prevention education. Prior to the first of the classes devoted to service learning, the students are asked to review the materials regarding service learning and prevention education on the online component of the course. Then the students are given a lecture on service learning including what service learning means and the goals we hope they will accomplish. In 2011, we are adding a lecture on stages of change and prevention education. In their small group sessions, students talk about what they have heard and begin the project selection process which is continued online. At the second class, the students plan their project, discuss the culture of the people with whom they will be interacting, and review the stages of change and prevention education material. Any other planning or discussion occurs on line. After the students have completed their project, a session is devoted to planning and designing a poster to be presented on the Service Learning Poster Day. The last service learning session is devoted to display of the posters and reflection of the activity and what they learned.
The intra-university support for these courses is incredible. All academic departments and several administrative departments in our University provide faculty/staff mentors and support. There is also outstanding collaboration with many agencies in Lake County. The county health department provides an update on the health concerns and population health statistics for the county and over 30 local schools and health care and social support agencies participate.
After taking the Interprofessional Healthcare and Culture course mandated to all first year on-campus students, students themselves wanted to do more. In 2013 they established a community-based free clinic offering services. This is one of the few student-run clinics in the country. Underserved and underrepresented populations are served: to date, over 200 visits with over 100 clients.
Student volunteers from the university in allopathic, podiatric, nursing, pharmacy, physical therapy, physician assistant, and psychology work at the clinic, with many others waiting for rotations at the clinic. They seek to provide patient care in: behavioral health, diabetes education, women’s health, podiatric care, pharmacological consulting, physical therapy, and health screenings. Faculty volunteers from various professions oversee the students.
Patients have complex needs, including co-morbidities, limited access, language barriers, transportation difficulties, lack of child-care, lack of understanding of payment sources, ability to navigate prescription filling processes etc. All of these challenges require care providers to be vigilant in efforts to assist patients through a complex health delivery system. It requires team approaches across professions especially in clinics.
A supervised and funded team is necessary to be able to successfully address these community needs in student-run free clinics (SRFCs). In the December 9, 2014 issue of JAMA, Sunny Smith, M.D. of University of California at San Diego, following a survey of student-run free clinics SRFCs concluded that “the lack of funding and sufficient faculty supervisors identified as the biggest challenges in SRFCs are actionable items because institutional support could help stabilize and improve these educational opportunities for years to come.”
Student volunteers from the university in allopathic, podiatric, nursing, pharmacy, physical therapy, physician assistant, and psychology work at the clinic, with many others waiting for rotations at the clinic. They seek to provide patient care in: behavioral health, diabetes education, women’s health, podiatric care, pharmacological consulting, physical therapy, and health screenings. Faculty volunteers from various professions oversee the students. They are hoping to expand services offered as well as times the free clinic is open. The Clinic is currently held on Thursday evenings.
They wish to expand patient services in areas such as women’s health, laboratory and imaging, pharmaceutical services and providing a transportation voucher program. Therefore grants can help students service the community better by providing assistance with laboratory fees, health assessment equipment (blood pressure cuffs, etc.), clinic supplies, computer needs and supply more vaccinations for clients.
The students are learning much about the social and quality issues embedded in the infrastructure of medical delivery resulting in better patient outcomes. The conclusion reached through the data in the October 2014 AAMC Analysis in Brief, Vol. 14, Number 10 was “ medical students who learn alongside students from a greater number of other health professions also report having a better understanding of collaborative, interprofessional care of patients, and significantly higher levels of overall satisfaction with medical training.” Our goal is to help them achieve this.
Lessons/Results/outcomes
Lessons Learned:
Several barriers to the initial implementation of the service-learning experience were identified:
(1) Lack of understanding the differences between volunteerism and service learning.
(2) Academic calendar conflicts between programs.
(3) Setting too few hours as a realistic time commitment.
(4) Lack of preexisting relationships with community partners.
(5) Engaging faculty mentors in the culture of service learning.
1. Lack of understanding regarding the differences between volunteerism and service learning.
Service learning is very different than volunteerism. Local community partners who are experts in their own cultures act as teachers by sharing this knowledge with students while the community itself becomes the classroom. Faculty mentors need to help educate students regarding the difference between projects that would commonly be considered volunteering and those which are truly service learning and result in reflection and engagement within the community.
2. Academic calendar conflicts between programs.
Interprofessional education may provide an opportunity to exchange skills and knowledge between professions and allows for a better understanding and respect for the roles of health care professionals. The coordination of almost 500 students in 8 programs, however, can be a logistical nightmare. The largest difficulty is finding a time that is suitable for all student schedules. Listing this course on all program syllabuses for all first-year students and having “by-in” from university department chairs can help make this coordination successful. Service projects are scheduled by the student group for days and times when there are no classes scheduled in any program.
3. Setting too few hours as a realistic time commitment.
In the 2004–2005 interprofessional health care teams course, there were 7 class sessions held from 4:00 pm–6:00 pm. Students and faculty both commented in post course surveys that the classes were too long and occurred too late in the day. In 2005–2006, class time was shortened to 1.5 hours and continued to be held in the evening. Class sessions were increased to 8 in 2005–2006 and 2006–2007. In 2008–2009, the same hours and length of class time were retained, but the number of sessions was increased to 9. This was done to allow time for the teams to discuss service-learning projects, course assignments, and to complete the poster development. In the past, students did this on their own time, and it was reported by students that it was difficult for all of them to get together. Hours allotted for service-learning projects have also changed over the years. In 2005–2007, students were asked to commit 4-40 hours for their projects, depending on the community partner needs. In 2008–2009, since there was such a discrepancy in how long groups spent with their community partners, a decision was made to ask students to perform their community projects for at least 8 hours. Students must spend enough time with their partners in order to accomplish the objectives set forth. HMTD 500 and 501 are held from 1-2:20 pm each Wednesday.
4. Lack of pre-existing relationships with community partners.
In 2005–2006, students were informed of only 6 possible community partners that had been utilized previously. Students were asked to go out among the community and identify partners and their needs. By the time of the completion of the projects for 2005–2006, there were 31 community partners. In 2006–2007, students returned to assist 23 of the 31 partners, helping establish our presence among the community. In 2007–2008, previous sites were revisited and new relationships with partners were established. Course coordinators have met with local health department directors to discuss the HMTD 500 course and service-learning component as a way to establish new relationships. It is necessary for course coordinators to reach out to community agencies, discuss objectives of the service learning component, and gain support from community members to allow students to coordinate projects with them. It is critical to discuss sites with all university departments to continue to establish a presence in the community and identify new organizations to assist. Our community outreach is strong at RFUMS, as is our relationship with our surrounding community partners. The HMTD course is an ideal opportunity for us to expand and grow theses relationships. Our goal is to continue to sustain relationships with these sites each year while adding new community partners to serve.
5. Engaging faculty and staff mentors in the culture of service learning.
As indicated previously, engaging faculty and staff members in the Interprofessional Health Care Teams course and in the service-learning project is critical to curricular success. The faculty and staff members are asked to act as a mentor on a volunteer basis. In addition to the actual number of mentors needed for each group, a list of substitute faculty is necessary because invariably someone is unable to attend all the sessions. To provide recognition for the faculty, the RFUMS president sends each mentor a thank you letter and a copy is placed in their personnel file.
From the pilot project we learned that we needed to get more buy in from the small group mentors and that we needed a more systematic approach to the prevention education training for our students. We attempted to get more buy in from the mentors through speaking with individual mentors and through discussions in the training sessions. We reworked the prevention education component and added additional web-based material for the students to read.
Evaluation Results:
Conclusion
The experience at RFUMS demonstrates that with commitment on the part of the administration and faculty, and with careful planning, it is possible to develop and implement an interprofessional prevention service-learning experience that is well received by faculty, students, and our community. Additional lessons to share are that it is advisable to have Directors overseeing the courses, have administrative help to prepare and distribute materials, hold training sessions for mentors, each week have a different set of student team leaders for the session and perhaps most importantly, create a university culture that embraces interprofessional prevention education.
Several barriers to the initial implementation of the service-learning experience were identified:
(1) Lack of understanding the differences between volunteerism and service learning.
(2) Academic calendar conflicts between programs.
(3) Setting too few hours as a realistic time commitment.
(4) Lack of preexisting relationships with community partners.
(5) Engaging faculty mentors in the culture of service learning.
1. Lack of understanding regarding the differences between volunteerism and service learning.
Service learning is very different than volunteerism. Local community partners who are experts in their own cultures act as teachers by sharing this knowledge with students while the community itself becomes the classroom. Faculty mentors need to help educate students regarding the difference between projects that would commonly be considered volunteering and those which are truly service learning and result in reflection and engagement within the community.
2. Academic calendar conflicts between programs.
Interprofessional education may provide an opportunity to exchange skills and knowledge between professions and allows for a better understanding and respect for the roles of health care professionals. The coordination of almost 500 students in 8 programs, however, can be a logistical nightmare. The largest difficulty is finding a time that is suitable for all student schedules. Listing this course on all program syllabuses for all first-year students and having “by-in” from university department chairs can help make this coordination successful. Service projects are scheduled by the student group for days and times when there are no classes scheduled in any program.
3. Setting too few hours as a realistic time commitment.
In the 2004–2005 interprofessional health care teams course, there were 7 class sessions held from 4:00 pm–6:00 pm. Students and faculty both commented in post course surveys that the classes were too long and occurred too late in the day. In 2005–2006, class time was shortened to 1.5 hours and continued to be held in the evening. Class sessions were increased to 8 in 2005–2006 and 2006–2007. In 2008–2009, the same hours and length of class time were retained, but the number of sessions was increased to 9. This was done to allow time for the teams to discuss service-learning projects, course assignments, and to complete the poster development. In the past, students did this on their own time, and it was reported by students that it was difficult for all of them to get together. Hours allotted for service-learning projects have also changed over the years. In 2005–2007, students were asked to commit 4-40 hours for their projects, depending on the community partner needs. In 2008–2009, since there was such a discrepancy in how long groups spent with their community partners, a decision was made to ask students to perform their community projects for at least 8 hours. Students must spend enough time with their partners in order to accomplish the objectives set forth. HMTD 500 and 501 are held from 1-2:20 pm each Wednesday.
4. Lack of pre-existing relationships with community partners.
In 2005–2006, students were informed of only 6 possible community partners that had been utilized previously. Students were asked to go out among the community and identify partners and their needs. By the time of the completion of the projects for 2005–2006, there were 31 community partners. In 2006–2007, students returned to assist 23 of the 31 partners, helping establish our presence among the community. In 2007–2008, previous sites were revisited and new relationships with partners were established. Course coordinators have met with local health department directors to discuss the HMTD 500 course and service-learning component as a way to establish new relationships. It is necessary for course coordinators to reach out to community agencies, discuss objectives of the service learning component, and gain support from community members to allow students to coordinate projects with them. It is critical to discuss sites with all university departments to continue to establish a presence in the community and identify new organizations to assist. Our community outreach is strong at RFUMS, as is our relationship with our surrounding community partners. The HMTD course is an ideal opportunity for us to expand and grow theses relationships. Our goal is to continue to sustain relationships with these sites each year while adding new community partners to serve.
5. Engaging faculty and staff mentors in the culture of service learning.
As indicated previously, engaging faculty and staff members in the Interprofessional Health Care Teams course and in the service-learning project is critical to curricular success. The faculty and staff members are asked to act as a mentor on a volunteer basis. In addition to the actual number of mentors needed for each group, a list of substitute faculty is necessary because invariably someone is unable to attend all the sessions. To provide recognition for the faculty, the RFUMS president sends each mentor a thank you letter and a copy is placed in their personnel file.
From the pilot project we learned that we needed to get more buy in from the small group mentors and that we needed a more systematic approach to the prevention education training for our students. We attempted to get more buy in from the mentors through speaking with individual mentors and through discussions in the training sessions. We reworked the prevention education component and added additional web-based material for the students to read.
Evaluation Results:
Conclusion
The experience at RFUMS demonstrates that with commitment on the part of the administration and faculty, and with careful planning, it is possible to develop and implement an interprofessional prevention service-learning experience that is well received by faculty, students, and our community. Additional lessons to share are that it is advisable to have Directors overseeing the courses, have administrative help to prepare and distribute materials, hold training sessions for mentors, each week have a different set of student team leaders for the session and perhaps most importantly, create a university culture that embraces interprofessional prevention education.
