University of Massachusetts Medical School Department of Family Medicine and Community Health
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Originally carried out as an expansion of one Population Health clerkship team as a way of including dental residents and a focus on oral health, the APTR IPE Institute gave rise to additional interprofessional learning opportunities as well as additional opportunities for medical and nursing students to learn and to practice oral health content. The University of Massachusetts Medical School’s 2008 interprofessional team included faculty from the medical and nursing schools as well as the dental residency director. Institute participation resulted in an expansion and deepening of work in two specific areas:
The specific initiative developed at the Institute was a new interprofessional population health clerkship for the required second year medical and nursing student clerkships. This new clerkship focused on improving oral health among vulnerable populations. Participating in the Institute supported the formalization and expansion of what had been mainly an informal interprofessional faculty team and ensured that the clerkship had the material and partners needed to implement a new oral health clerkship.
The significance of the oral health clerkship is that it went beyond simply being an experience for a small group of students; it laid the foundation for infusing oral health prevention into other education and practice opportunities. This included a one-half day interstitial learning session devoted to oral health for all medical and nursing students as well as an oral health student interest group. Largely as a result of attending the Institute and developing an oral health community health clerkship, oral health has been infused into multiple aspects of the curriculum. These include the new third year medical student Flexible Clinical Experiences as well as Senior Scholar and Capstone Projects.
Regarding interprofessional education overall, the school has modified its epidemiology/biostatistics course so that medical and nursing students are taught together, expanded the population health clerkship offerings and reviewed the service-learning pedagogy used for this clerkship to ensure that learners are learning not just with one another but from and about each other. Finally, other interprofessional learning opportunities have expanded through opening medical student elective pathways to nursing students. In their written reflections, students are asked to reflect on the roles and responsibilities of the various professions that comprise the interprofessional team and on how they see themselves functioning in an interprofessional setting.
- Oral health promotion and oral disease prevention across the medical and graduate nursing educational continuum
- Interprofessional learning opportunities overall
The specific initiative developed at the Institute was a new interprofessional population health clerkship for the required second year medical and nursing student clerkships. This new clerkship focused on improving oral health among vulnerable populations. Participating in the Institute supported the formalization and expansion of what had been mainly an informal interprofessional faculty team and ensured that the clerkship had the material and partners needed to implement a new oral health clerkship.
The significance of the oral health clerkship is that it went beyond simply being an experience for a small group of students; it laid the foundation for infusing oral health prevention into other education and practice opportunities. This included a one-half day interstitial learning session devoted to oral health for all medical and nursing students as well as an oral health student interest group. Largely as a result of attending the Institute and developing an oral health community health clerkship, oral health has been infused into multiple aspects of the curriculum. These include the new third year medical student Flexible Clinical Experiences as well as Senior Scholar and Capstone Projects.
Regarding interprofessional education overall, the school has modified its epidemiology/biostatistics course so that medical and nursing students are taught together, expanded the population health clerkship offerings and reviewed the service-learning pedagogy used for this clerkship to ensure that learners are learning not just with one another but from and about each other. Finally, other interprofessional learning opportunities have expanded through opening medical student elective pathways to nursing students. In their written reflections, students are asked to reflect on the roles and responsibilities of the various professions that comprise the interprofessional team and on how they see themselves functioning in an interprofessional setting.
impact
Established required 2nd year Clerkship serving 160 medical and nursing students per year. |
Medical and nursing students understand the importance of incorporating oral health into their assessment toolkit. Strengthened collaborations with County and Local Health Departments, Community Health Centers and other community agencies. |
APTR Project Proposal for 2007/2008 IPE Institute
At the Institute, the UMass team crafted plans for expanding interprofessional prevention education through developing a new community health clerkship focused on oral health as well as through a series of interclerkships that add nursing students and dental residents to the current medical student participants.
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Sustained the post-institute IPE activity or project after the initial year of implementation: Yes, but with major modifications |
All students in the new community health clerkship began the experience together. After an initial day of introduction to the epidemiology of oral health, the role of prevention, and the roles and responsibilities of each of the three professions, the student group divided into two smaller groups (each still with medical, nursing and dental students/residents) to focus on either children and primary prevention or on adults with developmental disabilities who require secondary and tertiary prevention. At mid-clerkship and at its close, the two groups reconvened to share experiences and learn from one another. This approach ensured that a didactic element was included with the hands-on, experiential core component of the clerkship.
The structure of the community health clerkship has always been based on the principles of service-learning, with sites identifying areas of interest and need for student engagement and students keeping a reflective journal. Recently, with the addition of the nursing students to the clerkship, faculty have learned from one another and provided more guidance to students in their reflection activities. At the conclusion of the clerkship, students present their clerkship experience at a poster session.
The topic of oral health, while developed during the Institute as focus for a full clerkship, resulted in additional opportunities for medical and nursing students to learn about oral health issues and to contribute to improving vulnerable patients’ oral health. These opportunities have occurred through the longitudinal capstone requirement, the third year flexible clinical experiences, and fourth year projects.
The Institute project also laid the ground work for developing a new interstitial clerkship devoted to oral health, with nursing students and dental residents joining the instructional day. In the past, interstitial clerkships had been structured as half- or full-day instruction primarily for students from the medical school. A total of eight interstitial clerkships occur during the medical students’ third year. In 2008, for the first time, nursing students attended two of these interstitial clerkships; dental residents facilitated teaching the day devoted to oral health. We expanded the interprofessional nature of these clerkships by including nursing students as all are appropriate for multiple professions. In 2008, one of our additional goals was to accommodate schedules so that dental residents could participate along with medical and nursing students in at least 4 of the 2008-2009 interstitial clerkships. With the dental residency having moved from UMMS, we no longer are able to include dental residents, but dentists and dental educators participate in the oral health clerkship. Finally, to reinforce interprofessional learning, we have added to all interstitial clerkships a component that focuses on roles and responsibilities of each profession related to the interstitial clerkship topics.
Current IPE ACtivity/Project Description
The impetus for our beginning an IPE initiative was the knowledge that health professions training curricula need to become interprofessional wherever and whenever the opportunity exists, and that a focus on prevention is entirely appropriate and relevant for these educational experiences. In addition, we wanted to expand beyond the medical/nursing student clerkship teams to include the dental residents who were on our campus. Furthermore, we ascribe to the idea that health professionals--expected to work together in teams—cannot do that well if they don’t know about each other’s roles and abilities. Finally, we had several faculty with public health backgrounds and who thus recognized, valued, and were familiar with interprofessional education. In 2004, we had moved the two week Population Health Clerkship (PHC) element of the required medical students’ Determinants of Health course and the Graduate School of Nursing students’ required Social Forces course to being an interprofessional immersion experience. The APTR IPE Institute offered us the opportunity to expand from a medical and nursing student oral health team to a team that included dental residents. At the time, we hosted a General Dentistry residency so we were able to meet the Institute requirement to be—at a minimum—a team of three different clinical professions. Since participating in the Institute, the General Dentistry residency has moved to an academic home with a dental school so we have reverted to being able to incorporate only two health professions in our educational teams. In an attempt to expand students’ familiarity with other health professions, as part of the clerkship we outline ways in which students can learn about other health professionals with whom they work during the two week experience. We have continued with full support from the academic leadership overall. In addition, our medical and nursing school administration and faculty as well as our statewide Area Health Education Center and the students themselves all support the interprofessional nature of this required clerkship. In fact, the interprofessional nature of this clerkship is a defining, structural feature.
The oral health focus of the clerkship has seeded other oral health learning opportunities for our medical and nursing students. One of these is specifically interprofessional, while the others are medical student projects that involve working on oral health issues with a range of other professionals. These include:
The oral health focus of the clerkship has seeded other oral health learning opportunities for our medical and nursing students. One of these is specifically interprofessional, while the others are medical student projects that involve working on oral health issues with a range of other professionals. These include:
- A required one-half day oral health interstitial clerkship for all medical and nursing students
- Through the Albert Schweitzer Fellowship, a medical student bringing oral health education and prevention to the local free clinics
- Development of a student oral health interest group
- A medical student working with medical assistants in one of our FQHC’s to teach them fluoride varnish, thus beginning a full fluoride varnish program for patients
- Eleven medical students participating in a fourth year oral health elective
- Three medical students developing culminating oral health projects
Structural Dimensions:
We use service-learning as the pedagogical underpinning for this Population Health Clerkship.
Students are expected to:
We conduct student assessments through responding to their reflective essays and posters as well as through specific information and feedback from their site preceptors. In instances where student teams are placed at some distance from the school, we work with those sites to explore the opportunity to provide housing.
The required Interstitial learning opportunity’s overall goal is to educate medical and nursing students on the importance of oral health in the care of individual patients. Faculty include physicians and nurses as well as dentists and dental hygienists. Student comprehension is assessed through a pre/post-test as well as a hands-on review. Student feedback regarding the day is uniformly positive.
We use service-learning as the pedagogical underpinning for this Population Health Clerkship.
Students are expected to:
- Prepare through reading and becoming acquainted with the work of the facility/organization to which they have been partnered
- Engage in a mini-service project that meets a need of that facility/organization
- Complete a series of reflective essays
- Develop and participate in a culminating poster session
We conduct student assessments through responding to their reflective essays and posters as well as through specific information and feedback from their site preceptors. In instances where student teams are placed at some distance from the school, we work with those sites to explore the opportunity to provide housing.
The required Interstitial learning opportunity’s overall goal is to educate medical and nursing students on the importance of oral health in the care of individual patients. Faculty include physicians and nurses as well as dentists and dental hygienists. Student comprehension is assessed through a pre/post-test as well as a hands-on review. Student feedback regarding the day is uniformly positive.
Human Dimensions:
For the population health clerkship experiences, we provide materials on-line for community preceptors and academic faculty. We also meet with community preceptors and discuss student feedback with them. In addition, annually, we facilitate a formal, in-person community preceptor/academic faculty development session. We have found these sessions to be very useful as preceptors and faculty have a chance to learn from as well as pick up ideas from one another. We ensure that all preceptors have access to our library resources; community preceptors who have precepted our students for several years are offered faculty appointments.
One of our oral health physician faculty champion’s, Dr. Hugh Silk, provides a faculty preparatory session for the interstitial clerkship faculty. Dr. Silk has taken the lead in planning this interstitial day. In addition, he precepts and mentors students who continue to develop their oral health knowledge skills through the flexible clinical experiences, capstones, and electives.
For the population health clerkship experiences, we provide materials on-line for community preceptors and academic faculty. We also meet with community preceptors and discuss student feedback with them. In addition, annually, we facilitate a formal, in-person community preceptor/academic faculty development session. We have found these sessions to be very useful as preceptors and faculty have a chance to learn from as well as pick up ideas from one another. We ensure that all preceptors have access to our library resources; community preceptors who have precepted our students for several years are offered faculty appointments.
One of our oral health physician faculty champion’s, Dr. Hugh Silk, provides a faculty preparatory session for the interstitial clerkship faculty. Dr. Silk has taken the lead in planning this interstitial day. In addition, he precepts and mentors students who continue to develop their oral health knowledge skills through the flexible clinical experiences, capstones, and electives.
Political Dimensions:
University leadership has embraced IPE as a priority. Moreover, our statewide Area Health Education Center, based at UMMS, continues to herald IPE and provide supportive resources. In addition to the required clerkship, our deans have encouraged the development of Observed Standardized Patient Clinical Experiences (OSCEs) in which medical and nursing students work together as a team and are assessed on their teamwork. IPE is included in our recent strategic plan and is embraced fully by the medical and nursing schools’ deans. Several years ago, that commitment was underscored as senior school leadership formed the Liaison Committee for Interprofessional Curriculum and initiated an annual call for proposals for an Interprofessional Education Grant (IPEG) Initiative. The goal of IPEGs is to stimulate the development of innovative approaches and programs in the school’s interprofessional education, across the spectrum of health professions, and the clinical and basic sciences. The priority areas have been team-based active learning and simulation, both with a focus on the Core Competencies for Interprofessional Collaborative Practice.
Notably, regarding IPE, the students are a driving force. They are asking for additional opportunities to learn about, from, and with one another. Recently, they have requested that nursing students become part of the medical students’ required small group Doctoring and Clinical Skills year-long course. Schedules continue to pose significant challenges, but with the students’ strong requests for this type of co-learning, the schedules might be adjusted to accommodate it.
University leadership has embraced IPE as a priority. Moreover, our statewide Area Health Education Center, based at UMMS, continues to herald IPE and provide supportive resources. In addition to the required clerkship, our deans have encouraged the development of Observed Standardized Patient Clinical Experiences (OSCEs) in which medical and nursing students work together as a team and are assessed on their teamwork. IPE is included in our recent strategic plan and is embraced fully by the medical and nursing schools’ deans. Several years ago, that commitment was underscored as senior school leadership formed the Liaison Committee for Interprofessional Curriculum and initiated an annual call for proposals for an Interprofessional Education Grant (IPEG) Initiative. The goal of IPEGs is to stimulate the development of innovative approaches and programs in the school’s interprofessional education, across the spectrum of health professions, and the clinical and basic sciences. The priority areas have been team-based active learning and simulation, both with a focus on the Core Competencies for Interprofessional Collaborative Practice.
Notably, regarding IPE, the students are a driving force. They are asking for additional opportunities to learn about, from, and with one another. Recently, they have requested that nursing students become part of the medical students’ required small group Doctoring and Clinical Skills year-long course. Schedules continue to pose significant challenges, but with the students’ strong requests for this type of co-learning, the schedules might be adjusted to accommodate it.
Symbolic Dimensions:
Interprofessional learning is stated as one of our university’s four strategic and supporting goals. Specifically, the recent strategic plan contains the following statement related to education: “As an innovative, interprofessional community of students and educators, we will build a health care delivery and biomedical research workforce that makes a lasting impact on human and community health.” In part, in order to carry out this goal, the university has made major investments in state-of-the-art educational technology and medical simulation as captured in the new interprofessional Center for Experiential Learning and Simulation (iCELs) center. In addition, with a goal of advancing interprofessional education, the school’s educational leadership has developed laboratory and OSCE enhancements. Specifically, several teaching cases have been carefully staged by a team of medical educators intent on teaching medical and nursing students the necessity of interprofessional teamwork to ensuring patient safety. One case in particular was coordinated by the Office of Undergraduate Medical Education to fulfill a second year medical education requirement for interprofessional learning and was developed with a grant from the Institute on Medicine as a Profession and Macy Foundations. This, as well as other cases, stress patient safety; as hands-on activities that create realistic situations, students experience the two essential elements for ensuring patient safety, i.e., team work and communication.
Interprofessional learning is stated as one of our university’s four strategic and supporting goals. Specifically, the recent strategic plan contains the following statement related to education: “As an innovative, interprofessional community of students and educators, we will build a health care delivery and biomedical research workforce that makes a lasting impact on human and community health.” In part, in order to carry out this goal, the university has made major investments in state-of-the-art educational technology and medical simulation as captured in the new interprofessional Center for Experiential Learning and Simulation (iCELs) center. In addition, with a goal of advancing interprofessional education, the school’s educational leadership has developed laboratory and OSCE enhancements. Specifically, several teaching cases have been carefully staged by a team of medical educators intent on teaching medical and nursing students the necessity of interprofessional teamwork to ensuring patient safety. One case in particular was coordinated by the Office of Undergraduate Medical Education to fulfill a second year medical education requirement for interprofessional learning and was developed with a grant from the Institute on Medicine as a Profession and Macy Foundations. This, as well as other cases, stress patient safety; as hands-on activities that create realistic situations, students experience the two essential elements for ensuring patient safety, i.e., team work and communication.
IPE OFFERINGS INCLUDE:
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PROFESSIONS/DISCIPLINES/SCHOOLS INVOLVED:
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FORMAL AFFILIATION AGREEMENTS WITH SCHOOLS MENTIONED ABOVE:
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ACADEMIC LEVELS TARGETED:
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COURSE DESCRIPTION:
- Number of students enrolled in IPE course during the most recent academic year: 160 (all second year medical and nursing students)
- Is this a shared/cross-listed course? Yes
- Title of Course(s): Determinants of Health/Population Health Clerkship
PLACEMENT SITES FOR ANY SERVICE-LEARNING COMPONENTS:
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EVALUATION METHODS USED FOR THE SUBGRANT PROJECT:
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LESSONS/RESULTS/OUTCOMES
Lessons Learned:
One very valuable lesson is that taking advantage of a modest opportunity to attend a multi-day institute can result in planting a seed that bears positive fruit of multiple varieties. Those fruits have benefited our school, our faculty, our students, our practices and our patients. Attending APTR’s 2008 Institute has enriched our educational offerings and has reverberated in numerous positive ways.
Evaluation Results:
Evaluation results affirm that medical and nursing students understand the importance of incorporating oral health into their assessment toolkit; they value the knowledge and skills they are able to develop through the variety of oral health focused educational opportunities we have been able to provide.
Unexpected Outcomes:
The topic of oral health has permeated our curriculum more fully and in ways that we had not anticipated. This has been a positive, unanticipated outcome.
One very valuable lesson is that taking advantage of a modest opportunity to attend a multi-day institute can result in planting a seed that bears positive fruit of multiple varieties. Those fruits have benefited our school, our faculty, our students, our practices and our patients. Attending APTR’s 2008 Institute has enriched our educational offerings and has reverberated in numerous positive ways.
Evaluation Results:
Evaluation results affirm that medical and nursing students understand the importance of incorporating oral health into their assessment toolkit; they value the knowledge and skills they are able to develop through the variety of oral health focused educational opportunities we have been able to provide.
Unexpected Outcomes:
The topic of oral health has permeated our curriculum more fully and in ways that we had not anticipated. This has been a positive, unanticipated outcome.